Do you really have tennis elbow?

Tennis elbow is definitely one of the most over diagnosed conditions that musculoskeletal physiotherapists see. Unfortunately, if you have pain ANYWHERE in the elbow the first diagnosis by your doctor or doctor google is ‘Tennis Elbow’. So what is tennis elbow and does it only happen to people who play tennis? In short the answer is no, you don’t have to be a tennis pro to get tennis elbow. The proper term is lateral epicondylitis and it’s when the wrist/finger extensors in the forearm become inflamed at their origin in the elbow.  Irritation of these tendons at the origin site is caused by repetitive strain (such as constantly hitting a ball with a tennis racket) but can also be caused by other repetitive tasks such as typing, cutting, using the mouse, gardening – you name it!

But what about those people who get diagnosed with ‘tennis elbow’ but it really isn’t? We see this often in the clinic and thought it was worth providing some food for thought into how the shoulder could actually be the culprit into what’s causing the elbow pain. In this modern day we are spending way more time on our computers and phones with poor posture (I’m sure you have heard this all before) and this over time can lead to your shoulder function declining. Progressively you may start holding your shoulder more protracted (hunched) and dropped. This then leads to your shoulder blade ‘winging’ which is when it doesn’t sit flush along your rib cage. Over time this weakens the shoulder blade muscles and creates tightness into the muscles in your chest and front of the shoulder. Now imagine your shoulder being in this position and then having to continue on with all that typing, cutting, mouse use, gardening. Sounds unsustainable right? Luckily for us, our body most of the time tries its best to function without causing too much of a fuss. So rather than give you pain signals straight away, it may choose another body part to try and kick into gear and help out with all that repetitive work. That is usually down near the elbow and wrist, where we see the muscles around the elbow and wrist trying to work overtime to compensate for a dodgy shoulder. In some other cases, you may actually just be getting referred pain from the shoulder and it just presents into the forearm and wrist. Check out the image below of how the supraspinatus muscle (one of the four rotator cuff muscles) refers pain down the arm, does it look eerily familiar?

supra pain referral

So perhaps to fix your elbow pain, you might actually need to fix your shoulder function?!

I remember when I was a new graduate working in my first job, I used to get terrible elbow and wrist pain on my right arm. I had really poor shoulder strength and with all the repetitive manual therapy I had to do I was dying a slow death each day! Lucky for me I was quick to work out that if I actually improved on my shoulder blade and rotator cuff strength, that my elbow and wrist pain would improve. So perhaps similar to me, this concept applies to you?

So if you feel like you have a niggling elbow or wrist, come and get it assessed – don’t just guess that its tennis elbow.