Do you have elbow pain?

Do you have pain in your elbow?

Does it hurt your elbow to grip or lift anything?

Do you have pain in your arm from repetitive tasks at work or home?

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You may be suffering from LATERAL ELBOW TENDINOPATHY (LET), or what is more commonly referred to as tennis elbow. Of course calling it tennis elbow is a bit of a misnomer because it is not only tennis players that get it and surprisingly it is more common in golfers than Golfer’s elbow! Both active and non-active people can suffer with this problem, and it is the most common issue seen in the adult elbow. 

LET occurs more commonly in the 40–55-year-old age group and is more prevalent in women. It occurs between 1-4% in the general population and in 15-30% of the working population particularly those whose jobs involve manual handling tasks. There is a higher risk of this problem developing in work that involves awkward hand and forearm postures, repetitive movements and the arm being subject to external forces for example in lifting tasks or tasks that involve the use of hand tools and machinery. 

Do I need to get a scan?

Initially a scan is not indicated, unless you have suffered a traumatic injury to your elbow such as a fall or a trip and are thinking you may have broken, aka fractured, a bone.

20-50% of the asymptomatic (pain and symptom-free) population will show changes on imaging – so imaging does not predict pain and diagnosis should be made based on clinical presentation. So it is not your first port of call, nor should you be concerned if you don’t have any pain but there are findings there on your ultrasound.

If you have had trialled physio for 6-8 weeks and pain is persisting investigation may be warranted. Ultrasound is your investigation of choice for this condition. Ultrasound technology is very good now and is generally sufficient when imaging is indicated, MRI is usually not indicated but XR may be required to rule out bony anomalies, fractures etc, which would indicate other issues. Therefore doctors will often order an Xray first to rule out any nasties and consider an ultrasound at a later date if needed.

Why is my elbow sore?

LET, like other tendinopathies is usually caused by a mismatch between the loads put on the tendon and the ability of the tendon to take that load. So basically you are asking the tendon to do more than it is capable. This can cause some inflammation or irritation of the tendon that may lead to some disrepair and degeneration in the tendon if it persists. 

Pain is usually present around the outside of the elbow and the back of the forearm. There are usually clear aggravating activities such as wrist/finger extension, lifting or gripping activities, especially gripping with the palm down as this particularly loads up the extensor tendons of the wrist. 

What can I do?

The first thing you need to do is stop the aggravating activity. Not all activity. You need to unload the tendon to stop irritating it. If you get it early enough, this may be all you need to do, so pay attention to when you get your pain. This could be as simple as just stopping lifting bags with your palm down or rotating out of the aggravating activity at work. You could also incorporate regular rest breaks from repetitive or aggravating movements.  Please note that stopping aggravating activities does not mean stopping everything. You can continue to do activities that are not aggravating, so keep up your daily walk, hold your dog’s leash in your other hand, keep playing soccer etc. Do not race off and get scans and get pushed down a pathway that sees you getting a steroid injection. Outcomes after corticosteroid injections are worse at 6 and 12 month follow up, with delayed recovery and higher recurrence rate. Outcomes after injection are worse than if you just wait it out and do nothing. Studies show the best outcomes in the initial 3-6 months are gained with appropriate physio treatment alone so see your physio asap. You could also trial a counterforce brace which you can find in most chemists, however if you would like to trial a good quality brace, we recommend the Mueller Hg80 Tennis Elbow Support, which is available at the clinic.  

What will happen at physio?

See your physio asap. The sooner we address the problem the easier it is to settle. Your physio will do a thorough assessment and determine the factors that are impacting on your pain. They will explain what is happening in a way that you can understand so you can be an active participant in managing your condition. Your physio can help you with advice on how to unload the tendon, advise you on self-management, ensure you do not get an injection that will have a long-term detrimental impact on your tendon health and provide manual therapy and appropriate exercises that can later be progressed to ensure you get the results you are looking for. 

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