Tennis elbow electrical stimulation

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players.

The one hand backhand in tennis can strain the extensor muscles and tendons of the elbow. But many other types of repetitive activities can also lead to tennis elbow--painting with a brush or roller, running a chain saw, and using different types of hand tools. Any activities that repeatedly stress the same forearm muscles can cause symptoms of tennis elbow.

Tennis elbow causes pain that starts on the outside bump of the elbow, the lateral epicondyle. The forearm muscles that bend the wrist back (the extensors) attach to the lateral epicondyle and are connected by a single tendon.

When you bend your wrist back or grip with your hand, the wrist extensor muscles contract. The contracting muscles pull on the extensor tendon. The forces that pull on these tendons increase when you grip things, hit a tennis ball using a backhand swing in tennis, or other similar activities.

Overuse of the muscles and tendons of the forearm and elbow are the most common reason people develop tennis elbow. Repeating some activities over and over again can put excessive strain on the elbow tendons. For example, hammering nails, picking up heavy buckets, using a screwdriver, or pruning bushes can all cause the pain of tennis elbow.

This condition is called tendinosis. In tendinosis, wear and tear leads to tissue degeneration. A degenerated tendon has an abnormal arrangement of collagen fibers.

Cells called fibroblasts attempt to heal the degenerated tendon. When this happens, the collagen loses its strength. It becomes fragile. Each time the collagen breaks down, fibroblasts form more scar tissue in the tendon.

Constant strain and overuse keep re-injuring the tendon. The scar tissue never has a chance to fully heal.

The main symptom of tennis elbow is tenderness and pain that starts at the lateral epicondyle of the elbow. The pain may spread down the forearm. It may go down as far as the middle and ring fingers. The forearm muscles may also feel tight and sore.

The pain usually gets worse when you bend your wrist backward, turn your palm upward, or hold something with a straight wrist or straight elbow. Grasping items also makes the pain worse. Just reaching into the refrigerator to get a carton of milk can cause pain. Sometimes the elbow feels stiff and won't extend fully.

The physical exam is often most helpful in diagnosing tennis elbow. By stretching the extensor tendons, the physician can reproduce the pain.

When the diagnosis is not clear, your doctor may order other special tests such as an MRI scan.

The key to conservative treatment is help the tendon heal.

If the problem is caused by acute inflammation, anti-inflammatory medications such as ibuprofen may provide some relief. If inflammation doesn't go away, your doctor may inject the elbow with cortisone. Cortisone is a powerful anti-inflammatory medication. Unfortunately, cortisone also weakens tendon tissue.

Physical or occupational therapists can help a great deal. At first, your therapist will give you tips how to rest your elbow and how to do your activities without putting extra strain on your elbow. Your therapist may apply tape to take some of the load off the elbow muscles and tendons. You may need to wear an elbow strap that wraps around the upper forearm in a way that relieves the pressure on the tendon attachment.

Your therapist may apply ice and electrical stimulation to ease pain and improve healing of the tendon. Electrical stimulation is often used to reduce pain and promote healing. The electrical stimulation is administered in the form of a transcutaneous electrical stimulation or TENS unit. This is a small device, about the same size as a deck of cards, that has two sets of leads connected to electrodes. The electrodes are applied to the skin and a small amount of current is used. The principal is similar to that of acupuncture.

Exercises are used to gradually stretch and strengthen the forearm muscles.

Because tendinosis is often linked to overuse, your therapist will work with you to reduce repeated strains on your elbow.

For more information about tendonitis, visit our sister site:
Tendonitis provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.

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