Duration of the therapy
Unfortunately, the therapy of tennis elbow can take several weeks or months. Basically, it is important that the affected arm is protected for several weeks, possibly immobilization with a plaster splint is also necessary. The conservative therapy should additionally consist of cooling the painful area and taking painkillers.
Short-term treatment success can be achieved by injecting local anaesthetics which inhibit the pain at its source. It is also conceivable to inject corticosteroids into the inflamed area, which can inhibit the immune response and thus reduce the pain. It is possible, however, that the symptoms may persist or improve only slightly despite adequate immobilization and regular stretching exercises.
If the complaints are very pronounced and persist over a period of six months, surgery may be considered. Since every surgical intervention has risks and in the case of tennis elbow surgery the success depends on the indication, the method used and the experience of the surgeon, the question of an operation must always be clarified with an experienced doctor. As a rule, conservative therapy is started.
This means that at first everything is done to treat tennis elbow without surgery. This is successful in almost all cases. The healing rate is 97% with the right therapy.
It is particularly important to spare the affected arm. Of course, the very movement that caused the complaints should be avoided, but other strains on the arm should also be avoided as far as possible. There is also the possibility of applying a bandage to a particular tennis elbow, also called an “epicondylitis brace”.
This is a bandage that usually has to be worn for several days and relieves the painful muscles and tendons. You can find more information about the tennis elbow brace in our topic:
- Tennis Bracelet
- Forearm bracelet
Tapes can help with sports and can be more individualized as an alternative to a bandage. Many more common in conservative therapy are the kinesiotapes, which support healing and detonate the muscle.
Exercises to stretch the muscles affected by the inflammation in tennis elbow are very important to achieve a good treatment success. Patients can and should do these simple stretching exercises on their own. In tennis elbow, stretching should be done as often as possible to maintain the mobility of the affected muscles.
Regular stretching also strengthens the attachment tendons and ligaments of a muscle. The stretching of the muscles in tennis elbow should not be performed jerkily, but slowly and carefully. Five muscles are located at the lateral epicondylus of the humerus: These muscles are responsible for stretching in the wrist, stretching and spreading the fingers, and partly for slight flexion in the elbow joint.
- M.
extensor digitorum (finger extensor)
- M. extensor digiti minimi (small finger extensor)
- M. extensor carpi ulnaris (ulnar hand extensor)
- M.
extensor carpi radialis (radial hand extensor) and the
- M. supinator (forearm twister).
To heal tennis elbow, it is important to relieve the irritated tendon attachment. The tension, which is permanently on the tendon, should be reduced.
To achieve this, the stretching of the above-mentioned muscles is the most important factor. In addition, overloading activities must be avoided. For stretching, the arm should be held forward with the elbow stretched.
The palm of your hand should point towards the ground. Now bend the wrist and if necessary increase the resulting stretch by pulling or pushing the other hand. In this way the wrist extensors can relax.
This is repeated three to four times a day for about 4 x 20 seconds. Alternatively, you can also lean against a wall with straight arms. The fingers point inwards, upwards and downwards.
The palm of your hand lies as smoothly as possible against the wall. In order to counteract permanent overloading, an ergonomic form of keyboards and mice and break times should be ensured, especially in everyday working life. In more severe cases, an experienced physiotherapist can also help in selecting and performing the right exercises.
You can find more information about stretching with tennis elbow under Stretching exercises for tennis elbowThe tennis elbow is a classic tendon insertion disorder, caused by overloading and incorrect strain on the forearm extensor muscles. Shockwave therapy has been proven to have a positive influence on this clinical picture when other measures, such as a medicinal pain and inflammation therapy (NSAID cortisone), cross-friction massages, physical therapy measures (electricity, etc.) have not led to the desired success.
In any case, it is worth trying shock wave therapy before surgical measures are applied. In contrast to the calcified shoulder, low-energy shock waves (or pressure waves) are often used successfully. This is due to the fact that the tendon tissue to be treated lies directly under the skin and is reached by the low-energy shock waves almost unattenuated.
This presumably initiates regenerative processes that promote healing. Physiotherapy can also be useful. This includes certain stretching exercises that relieve pain and promote the healing process, as well as some special massage techniques, for example the transverse massage of the muscles of the wrist, also called transverse friction.
We have written a separate topic on the subject of physiotherapy and tennis elbow. Treatment with locally applied ultrasound or microwaves can also reduce pain and can be used either alone or in combination with the massage to increase the blood flow to the muscles before the massage. Other options for more advanced cases are shock wave therapy.
Treatment with locally applied ultrasound or microwaves can also reduce pain and can be used either alone or in combination with massage to increase blood flow to the muscles before massage. Other options for more advanced cases are shock wave therapy. The next step in the treatment process is medication.
Here, too, the physician is offered different options, which are more or less useful in the case of tennis elbow and should definitely be discussed with the patient before starting treatment. First of all, bandages soaked with ointments may contain anti-inflammatory substances (e.g. Voltarene emulgel). Such preparations can also be taken orally (e.g. Voltaren, Arcoxia) as an alternative.
In addition, it is possible to apply a mixture of such anti-inflammatory agents and local anaesthetics to the affected muscle attachment. The anaesthetic is injected around the nerves, which causes a blockage of the nerve conduction and no pain is felt. In addition, classical painkillers are of course also used, especially from the circle of antirheumatic drugs (antiphlogistics = NSAIDs).
Alternatively, however, some herbal preparations (e.g. Zeel©, Traumeel©), enzymes, nucleotides or drugs for muscle relaxation can also be used.The aching tennis elbow can be rubbed with anti-inflammatory and/or pain-relieving ointments and bandaged for protection. However, pain-relieving ointments are usually not a permanent therapy, because this is only to relieve the pain. The advantage of ointments is that they (generally) cannot cause side effects that affect the whole body.
On the other hand, one should be careful with the continuous intake of pain medication and, if necessary, discuss this with one’s doctor. This frequently used ointment contains the active ingredient diclofenac. It thus belongs to the group of so-called non-steroidal anti-inflammatory and pain-relieving anti-inflammatory drugs.
This ointment is also recommended by the manufacturer for use with tennis elbow. The ointment should be applied to the affected elbow three to four times a day. If you still have to wear clothing over it, a light bandage will help.
The amount used should be cherry to walnut size (1-4g). Usually such an ointment bandage can be used for one to three weeks. Otherwise the use should be discussed with a doctor.
If the tennis arm complaints are acute, an injection of cortisone at the irritated tendon insertion can provide rapid relief. This can last for several weeks. Today, however, regular injections of cortisone (cortisone injection) and the administration of cortisone in chronic tennis arm complaints are not recommended.
The reason for this is that cortisone can have a negative effect on the metabolism of the tendon and thus on permanent healing. For this reason, the decision as to whether a therapy with local cortisone injections should be attempted in the short term remains with the treating physician. In the early stages, a cortisone injection is an entirely applicable therapy option.
The effectiveness of the cortisone injection diminishes with increasing duration of illness. Systemic administration of cortisone should be viewed critically. For acute symptoms, an envelope with curd cheese can help: To do this, smear a (kitchen) cloth with quark and then place it on the affected elbow.
If possible, the curd should come directly from the refrigerator. If it has warmed up on the body, you can wash off any remaining curd with water and repeat this process several times if necessary. Other ointments, such as calendula ointment, can also be applied to the elbow. In addition, a hay flower bath for the affected arm leads to relaxation and relief of pain. Hay flowers can be bought in the pharmacy.