Note
You are on a subpage of our more extensive page Tennis Elbow.
Synonyms
Tennis elbow, tennis elbow, tennis elbow, epicondylitis humeri radialis
Introduction
This topic deals with the physiotherapeutic treatment of tennis elbow as an important and promising component of conservative therapy. Unfortunately, due to the increasing budgeting of physicians, especially in the field of orthopedics, it is used far too seldom in the therapeutic area. Studies have shown that the significance of physiotherapeutic treatment in terms of healing success is at least equal to other therapeutic options such as: and that the therapeutic success is even more lasting in the long run.
- Medication
- Cortisone infiltrations
- Acupuncture
- Shock wave etc.
Diagnosis
The diagnosis of tennis elbow and the differentiation from the so-called golfer’s elbow, where the pain is localized on the inside of the elbow, is mainly made by questioning the patient and by special manual testing procedures, which will be discussed in more detail later. This form of diagnosis can be carried out by physiotherapists, who rely on their senses (eyes, ears, hands) for the examination and therefore have a lot of experience in manual examination techniques, while the physicians also have the apparatus-based diagnostic procedures at their disposal. The physiotherapist does not use the test procedures to make a diagnosis, but as an instrument for re-evaluation after treatment.
1. history – anamnesis
- The patients are predominantly between 30 and 50 years old.
- Pain indication above the outer joint part of the elbow, radiating into the hand or upper arm.
- Restriction of habitual everyday movements, even shaking hands or lifting a coffee cup can lead to severe pain in the acute stage.
- In most cases, this is preceded by overloading of the forearm extensor muscles. This does not necessarily have to be playing tennis, professional overloading can also be present. Particularly one-sided, monotonous, unaccustomed activities involving a high input of force are a frequent cause.
- Patients often have a phase of acutely painful inflammation already behind them when they are referred to a physiotherapist.
- Later: loss of strength of the entire arm musculature.
- X-ray CT (computed tomography)MRT (magnetic resonance imaging)/ultrasound (sonography) or laboratory values are usually inconspicuous, especially in the acute stage.
The patient is asked to grasp a chair back from above with stretched elbow and lift the chair.
If the patient reports a known pain in the outer area of the elbow during this procedure, the test is positive. With the elbow stretched, the patient should raise his hand against the resistance of the therapist. If this causes the typical pain, the test indicates an existing tennis elbow syndrome.
The patient is asked to stretch his middle finger against the resistance of the therapist with the forearm in place. If the pain is known to be provocative, the test is positive. The patient is asked to turn his forearm against the resistance of the therapist from “inside out” so that after the movement the palm of the hand looks up.
This test is also positive if the movement of the forearm against resistance causes pain to increase at the outer elbow. The test procedures described are so-called provocation tests, i.e. the examiner tries to provoke the “known” pain of the patient by a certain posture or movement. The extensor muscles are examined for pain and reduction of strength under tension.
More precise information about the affected tissue structure (muscles, tendon, tendon insertion) can be determined by means of palpation. The bone attachment of the affected musculature and the forearm muscles in its course at the back of the forearm are strongly painful under pressure. Often, painful areas are also found on the inside of the elbow in the area of the muscle attachments of the forearm flexor muscles.
Not all tests have to be positive for a diagnosis to be made. The extensor muscles of the wrist are most frequently affected.These tests in connection with the questioning of the patient are nevertheless so meaningful that in most cases an involvement of the shoulder joint or cervical spine can be excluded. The tests are also important when the patient is re-founded in order to get a statement about the success of the physiotherapeutic treatment.
