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Pain is one of the most predominant symptoms that has led humankind to kneel before it. One such piece of equipment is the Tennis Elbow Brace. Along with this, a tennis elbow strap, elbow sleeve, and wrist splint are also used to provide support to the elbow and wrist and limit the activity.
Humans’ incapability to tolerate pain has given a kickstart to tremendous research on managing pain 1and methods to alleviate it. The man can cross every limit to find a solution to stop or at least control the pain.
For ages, many advancements have been seen in the equipment that helps control the pain or prevent it from worsening.
You might wonder what a Tennis elbow brace2 is, what it looks like, why it is used, is helpful, and many more questions that are okay to pop up.
Well, this article is the perfect fit for all your unanswered questions and to solve your dilemma of whether to use a tennis elbow brace or not.
1. Tennis Elbow
Well, this word gives us an insight that this condition commonly occurs in people who play tennis or those who have a similar action as that of tennis players while performing day-to-day activities.
And this action is a repetitive extension of the elbow joint which means taking the hand away from the shoulder. This makes the tennis elbow an overuse injury.
An extension is the most predominant action when combined with the supination of the forearm, causing an increase in the chances of developing the tennis elbow.3
Now for the extension to occur at the elbow, the extensor muscles of the forearm need to work efficiently.
These extensor muscles have a common origin in the lateral epicondyle of the humerus.
Repetitive extension of the elbow causes an excessive strain on this origin and leads to microtrauma.
This microtrauma is followed by the inflammation of the common tendon of the extensors leading to tendonitis. Thus, this condition is also called lateral epicondylitis4.
2. Prone To Developing Tennis Elbow
Tennis elbow is a widespread condition compared to Golfers elbow or medial epicondylitis.
As the name suggests, tennis elbow commonly occurs in tennis players and athletes who perform throwing and hitting actions.
As these actions involve forceful muscular contraction, a repetitive strain on the extensor tendons leads to an increased chance of developing tennis elbow or lateral epicondylitis5.
Some of the common sport that has a high prevalence of developing tennis elbow are:
- Tennis
- Javelin Throw
- Cricket
- Hockey
- Volleyball
- Basketball
- Rowing
- Shotput
- Archery
- Skiing
Another common group prone to developing tennis elbow is homemakers or housemaids.
As these people have a habit of squeezing clothes using their hands, an action of extension combined with twisting motion of the elbow leads to an increase in the chances of developing tennis elbow.
A sudden vigorous muscular contraction or sudden forceful elbow extension causes muscle pull and leads to tennis elbow.
Patients diagnosed with arthritis are also prone to developing tennis elbow as the erosion of the bony surfaces may lead to irritation of the tendons of the extensor muscle group and subsequent inflammation.
3. Expectation From Tennis Elbow
Pain being the most predominant factor for the tennis elbow, it should not be considered the differentiating factor for this condition as the pain has many possible reasons.
Well, tennis elbow has a classic group of signs and symptoms that occur collectively, classifying it as tennis elbow.
The common signs are:
3.1. Tennis Elbow Pain
To any injury that occurs to the body, pain is the immediate response and an important one as well. Usually, tennis elbow pain occurs in the dominant hand rather than both elbows. The most point to term the pain as tennis elbow pain is determining when the pain occurs.
Tennis elbow pain usually occurs when performing an action that involves the combination of extension and supination. Another common complaint of tennis elbow pain is an increase in pain early in the morning after waking up which reduces with a little bit of activity.
3.2. Tenderness
Another common cause of discomfort is tenderness. The pain can be elected when the site of muscle insertion is touched. The facial expressions usually change, reflecting that the area is sensitive to touch due to underlying swelling. Tenderness usually is present in acute phases of injury and subsides quickly on treatment.
3.3. Erythema
Erythema is a reaction elicited by the body to any inflammation.
The superficial blood vessels dilate, leading to an increased blood flow to that area.
This leads to redness over the area, which is one of the earliest signs of tennis elbow.
3.4. Swelling
The classical sign of inflammation is swelling, which is again one of the earliest signs of inflammation.
This usually is seen in the early stages of the injuries and causes severe discomfort to the affected individual.
In acute stages, this sign usually is the first one to appear and lasts till the inflammation resides.
3.5. Decreased Range of Motion
Range of motion is a physical quantity that is usually measured by a physical therapist using a device called a goniometer.
Range of motion is the ability of a joint to move through a spectrum of range of movements.
The range of motion is not the same and changes individually.
The main reason behind the decrease in the range of motion is pain.
Pain is the predominant factor that limits the movement at the elbow and affects the range of motion of the joint.
3.6. Pain on Specific Activity
The activities that involve movements like a full extension of the forearm along with the forceful twisting motions of the elbow lead to severe pain leading to the abolishment of the activity.
Such movements are seen in activities of daily life like squeezing clothes, lifting objects, sweeping the floor, and many more.
In sports like tennis and cricket, these are the fundamental movements that are necessary and can not be avoided, thus affecting the performance of the player.
Forceful completion of the movement despite its limitation may lead to microtear of the tendons leading to aggravating the condition and unbearable pain.
3.7. Change In The Grip Strength
Grip strength is determined by the active and forceful contraction of the forearm muscles.
Grip strength is essential for holding objects in hand like a bottle, handbags, and many other daily living things.
As the extensor muscles are affected, their forceful contraction is painful, leading to a decrease in grip strength.
3.8. Stiffness In The Elbows and Wrist
Stiffness in the elbows is another common cause of discomfort and a problem experienced by many a patient.
This symptom is usually experienced early in the morning or after a period of prolonged rest or inactivity.
Stiffness in the wrist is also common and is seen in severe conditions of overuse injuries.
3.9. Painful Wrist
The wrist joint bones provide insertion for the extensor muscles of the forearm. Thus, the wrist is commonly involved in almost all cases of tennis elbow.
The wrist is commonly used in day-to-day activities of life and is an essential link between the forearm and the hand.
Actions like wrist flexion and extension become painful due to active contraction of the extensor muscles.
Also, in severe cases, the wrist range of motion is affected.
In some cases, the pain may also radiate to the arm
4. Cure For Tennis Elbow
Pain relief has always been a challenging task for many a physician across the globe as the response to a particular treatment varies from person to person.
This never-ending phenomenon has led to extensive research. It has been identified that an approach to such a condition should be a conservative approach to avoid further aggravation of the condition.
The available treatment options are:
4.1. Physical Therapy
Physical therapy is one of the best treatment options for the pain caused due to the tennis elbow.
Physical therapy is an evidence-based approach that involves assessment, diagnosis, and management of the condition, which a physical therapist usually does.
In this approach, the severity of the condition is measured, and a treatment approach is planned accordingly.
Pain management is the first step, which includes the use of electrotherapy modalities, manual therapy, and exercise therapy.
Electrotherapy modalities like Trans Cutaneous Nerve Stimulation and Interferential Therapy are used to reduce pain and inflammation. Position release techniques are also used along with manual therapy techniques like myofascial release.
For exercise therapy, a strict program is designed and followed to regain the lost range of motion and reduce the stiffness of the elbow.
After control over pain is achieved, exercise training is started mainly to increase the range of motion and grip strength.
The exercises usually are active and are then progressed to actively resisted exercises.
Along with this, cryotherapy is also used to reduce the signs of inflammation and provide pain relief.
4.2. Tennis Elbow Brace
An Elbow brace is one of the practical and most commonly used devices to help with elbow pain which is caused due to various conditions. A tennis elbow brace is specially designed for relieving pain caused due to tennis elbow or lateral epicondylitis.
A brace is a supportive aid that helps provide relief from pain and tenderness caused due to weight-bearing and strain injuries. A tennis elbow brace is specially designed by keeping the anatomy of the elbow in mind so that it provides maximum comfort and pain relief.
A tennis elbow brace is a type of forearm brace that is one of the preferred conservative treatments for the tennis elbow. A tennis elbow brace has Velcro straps that can help adjust the brace around the elbow and thus make a desirable fit for the elbow.
A tennis elbow brace works by helping in reducing the strain and weight on the help. This, in turn, helps reduce the pressure on the elbow, provides relief from elbow pain, and reduces tenderness. Doctors highly recommend a tennis elbow brace as it is readily available and efficient.
But while buying a tennis elbow brace, one must make sure that the brace is washable and made up of material that has quick-dry properties. It is noted that the material used to make the tennis elbow brace out irritates the skin and causes itching.
This problem is common and goes away with one or two washes. After a long period of continuous use, the brace may lose its efficiency, or the straps may no longer hold the brace in position; thus, changing the brace is recommended. The tennis elbow brace also limits the activity of the elbow and thus provides rest to the elbow.
4.3. Tennis Elbow Strap
A tennis elbow strap is highly precise and fits around the lateral epicondyle rather than the entire forearm.
A tennis elbow strap provides a compression-like effect around the lateral epicondyle and helps reduce the signs of tennis elbow.
A tennis elbow strap is also used for conditions like Golfer’s elbow.
The compression caused by the strap also helps to reduce inflammation.
4.4. Elbow Sleeve
An elbow sleeve is usually worn around the elbow and is made up of fabric that is slightly elastic and thus fits perfectly around the elbow. This also provides a compressive effect around the elbow and is used to prevent overuse injuries.
The sleeve used also provides full elbow extension and reduces the stress on the joint.
4.5. Wrist Splint
A wrist splint is also used to reduce the pain in the wrist joint.
The splint also comes with thumb support which helps keep the wrist in a neutral position and limits the action of the wrist joint.
It can be used while performing the activities of daily life and helps reduce the strain on the tendons.
4.6.Corticosteroid Injection
Another intervention used to reduce the symptoms of tennis elbow is corticosteroid injections. These injections are directly administered into the elbow into the joint space and are only recommended in severe cases where conservative management has failed.
Before taking a corticosteroid injection, one must be aware of the possible side effects like nausea, vomiting, urticaria, and diarrhea. The injection is usually given every 3 or 6 months, depending upon the presenting condition.
The site of injection is usually changed to avoid ulceration. Injection site pain and discoloration are common and usually, go away within 4 or 5 days after the administration of the injection. The symptoms are reduced instantly, and the relief is felt within 2 or 3 days after taking the injection.
It is assumed that the corticosteroid exerts an effect on the pathway of inflammation and blocks the pathway, thus reducing the signs of inflammation. The influence is exerted on multiple stages of inflammation; therefore, maximum relief occurs.
4.7. Surgery
When conservative management and medical intervention are failed and produce no significant improvement in the condition, the surgery is taken into consideration.
Arthroscopic surgery is usually done. In this procedure, two small incisions are made on the medial and lateral aspects of the elbow.
A specialized needle is inserted through these cuts under radiographic guidance, and the damaged part of the tendon is cut and removed. The tendon is then reattached, and the incision is sutured back again.
After the surgery, the elbow is kept in a rested position, and the suture site is examined periodically to rule out any developing infection. Before undertaking the surgery, one must consult a certified orthopedic surgeon and clear all the doubts related to the surgery.
Orthopedic surgeons usually take this as the last option for the treatment of tennis elbow. After a successful operation, a strict rehab is necessary to return to the normal range of motion and do the activities efficiently.
4.8. Other Treatment Options
Anti-inflammatory drugs like Non-Steroidal Anti Inflammatory Drugs (NSAIDs) like diclofenac and ibuprofen are used in the form of sprays and creams.
Ultrasound therapy also helps reduce inflammation.
Techniques like phonophoresis, which is the administration of anti-inflammation drugs6 through the skin under the influence of ultrasonic waves, are used. This is the topical administration of the drugs. The most common form is the gels or creams.
The use of IRR is also beneficial in some cases and should be taken with caution.
5. Conclusion
Tennis elbow is a common overuse injury and commonly occurs in sports involving throwing and hitting actions. Pain during activity is the most common symptom, along with tenderness, swelling, and erythema. The treatment includes conservative management, medical management, and surgical approach.
The most common method of conservative treatment is the use of a tennis elbow brace which is a forearm brace. The tennis elbow braces come in a variety of options in size and shape and can be adjusted according to the individual’s needs.
The wrist is also involved in severe cases and should be taken appropriate care of with wrist splints. The tension caused by the elbow braces and straps should not be excessive and very tight. For quick recovery, use a combination of available treatment options.
Along with this, avoid overuse of the elbow and provide maximum rest. Regular stretching of the forearm muscles also helps in reducing pain. The stretch should be within the limits of pain, and excessive stretching should be avoided. In severe cases, elbow support is also used.
FAQs
1. Can I continue playing sports or working with tennis elbow?
A. It’s advisable to avoid activities that worsen your symptoms, as continued strain on the affected tendons can hinder the healing process. Modify your activities and use proper techniques to reduce strain on the forearm.
2. Are there ways to prevent tennis elbow?
A. To reduce the risk of developing tennis elbow, it’s important to use proper technique when performing repetitive tasks, avoid overexertion, and engage in regular forearm-strengthening exercises.
3. Can tennis elbow recur after treatment?
A. Yes, tennis elbow can recur, especially if the underlying causes and contributing factors are not properly addressed. Following recommended preventive measures and maintaining proper techniques can help reduce the risk of recurrence.
Read more
- Caudill, Margaret A. Managing pain before it manages you. Guilford Publications, 2016. ↩︎
- Bisset, Leanne, and Brooke Coombes. “Tennis elbow.” BMJ clinical evidence 2011 (2011). ↩︎
- Nirschl, Robert P., and Edward S. Ashman. “Elbow tendinopathy: tennis elbow.” Clinics in sports medicine 22.4 (2003): 813-836. ↩︎
- Johnson, Greg W., et al. “Treatment of lateral epicondylitis.” American family physician 76.6 (2007): 843-848. ↩︎
- Whaley, Andrew L., and Champ L. Baker. “Lateral epicondylitis.” Clinics in sports medicine 23.4 (2004): 677-691. ↩︎
- Shau, Wen-Yi, et al. “Risk of new acute myocardial infarction hospitalization associated with use of oral and parenteral non-steroidal anti-inflammation drugs (NSAIDs): a case-crossover study of Taiwan’s National Health Insurance claims database and review of current evidence.” BMC cardiovascular disorders 12 (2012): 1-16. ↩︎
Last Updated on by Sathi Chakraborty, MSc Biology
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