Extensor Tendinopathy - otherwise known as Tennis Elbow

What is it?

Commonly referred to as ‘tennis elbow’, extensor tendinopathy refers to degeneration and inflammation within the tendons on the outside of the elbow. These tendons connect the forearm muscles to the arm bone. The muscles function to move the wrist, hand and fingers.

How does it happen?

Extensor tendinopathy is a common injury associated with activities requiring repetitive use of the wrist and hand, and results from overuse of the tendons on the outside of the forearm. The function of these tendons is to transmit forces produced by the forearm muscles to their origin from the bone. Repetitive use of the forearm muscles and, therefore, the forearm tendons can lead to microscopic tears within the tendons and degeneration or breakdown of the tendons. To repair this degeneration the body commences an inflammatory response.

How does it feel?

The primary sensation with the extensor tendinopathy is pain felt on the outside of the elbow and forearm. This pain typically develops gradually. Initially, it may only be painful following exercise. Associated with the pain may be stiffness or tightness in the elbow and forearm region. Typically these initial signs of extensor tendinopathy are ignored as they disappear quickly with the use of the arm or applying heat (i.e. a hot shower) over the elbow and forearm region. However, as you continue to exercise, the tendinopathy progresses and the pain within the tendon becomes more intense and more frequent. In the earlier stages, this pain during exercise may initially disappear as you warm up, only to return when you cool down. However as you continue to exercise, the tendinopathy worsens and your pain may begin to present for longer periods during exercise until it is present all of the time. This may interfere with your performance.

What should you do?

Extensor tendinopathy generally does not get better on it own if the cause is not addressed and you continue to exercise. If you have or suspect you have extensor tendinopathy you should consult your sports physiotherapy at Balgowlah Physiotherapy. In the meantime you can begin initial treatment. This should consist of icing following exercise and regular gentle stretching of the forearm muscles. Icing may consist of crushed ice wrapped in a moist towel applied for 15-20 mins or ice in a paper cup massaged over the outside of the elbow until the skin is numb.

What shouldn’t you do?

If you have or suspect you have extensor tendinopathy, you shouldn’t ignore the problem. Your pain may get better as you exercise; however the exercise you are doing may be interfering with the healing process and causing further damage. This can lead to your injury getting worse such that your pain does not ‘warm up’ and you feel it throughout exercise. If this occurs, your recovery may be prolonged and it may take a number of weeks or months for you to return to full exercise and sport.

Could there be any long-term effects?

Extensor tendinopathy does not produce any long term effects as long as it is properly diagnosed and appropriately treated, if not, it can lead to prolonged pain on the outside of the elbow and prolonged lay off from exercise and sport.

Management

The assistance of a sports physiotherapist is important in the treatment of extensor tendinopathy. At Balgowlah Physiotherapy, we can assist in diagnosing the problem and its severity. This may require referral for an ultrasound examination to confirm diagnosis. From this, the sports physiotherapist will be able to determine an appropriate treatment plan. This may involve activity modification, soft tissue treatment such as massage and stretching, and the progression through a series of specific strengthening exercises. Your sports physiotherapist will also be able to assess and determine why you developed extensor tendinopathy and address this during your recovery to prevent re-occurrence when you return to full activity.

Brukner & Khan (2012) Clinical Sports Medicine.