The Tennis Elbow: Symptoms And Diagnosis

The tennis elbow or epicondylitis is a disease that manifests itself as pain in the elbow area.

Epicondylitis, also known colloquially as tennis elbow, is an inflammation of the epicondylus tendons. These are the ligaments that connect the muscles of the forearm and hand to the lateral epicondyle of the humerus on the outside of the elbow. The inflammation is caused by microtrauma due to muscle overload. Read on below to learn more about tennis elbow symptoms and diagnosis.

The tennis elbow is a very common disease in the sport, hence the name. However, the disease is not limited to exercise, as it can also occur at work. There are professions that have a greater tendency to develop this injury due to the repetition of certain gestures.

This is especially the case in factories, when doing office work with a computer, at painting or during activities that result in overexertion of the muscles responsible for hand movements.

The tennis elbow and its symptoms

The symptoms of epicondylitis appear insidious. Generally, patients experience pain on the outside of the elbow that can extend into the forearm.

You may feel uncomfortable reaching for objects, moving your fingers, twisting your wrist, and pressing the affected area where the muscle is connected to the ligaments. In addition, there may be a lack of strength in the forearm.

The tennis elbow: diagnosis

It is extremely important to properly diagnose the cause of the elbow pain in order to institute the correct treatment, as there are several medical conditions that can have similar symptoms and this can lead to confusion.

Treatment-resistant epicondylitis that is the result of confusion in diagnosis is usually due to entrapment of the posterior interosseous nerve on the side of the elbow. Below are some conditions that cause pain similar to tennis elbow:

• Neuropathy due to entrapment of the radial nerve.
• Radio-humeral joint osteochondritis.
• Pain in the surrounding muscles, which, although not directly related to the area in which you are feeling the pain, can still cause discomfort.

• Changes to the radial head, which is on the outside of the elbow.

To correctly diagnose epicondylitis, your doctor will follow this protocol:

1. Patient history

• Visual Exam: The doctor will first perform a full examination of the physical appearance of the affected area. He looks for signs of inflammation, skin changes, deviations in joint alignment, etc.
• He will locate the epicondyle and apply pressure to see if the patient feels any pain in that area.
• Varus Elbow Stress Test: Pressure is applied to the elbow, causing its distal surface to move toward the core of the body. The test will be positive if the patient complains of symptoms.

• Pain when you drag your fingers with resistance.
• Examination of the mobility of the elbow and the radial head, the cervical spine and the entire shoulder joint system.
• In addition, the doctor collects information about the patient’s daily activities that can affect the condition. And drugs that the patient has recently taken must also be taken into account.

Pronation and supination

It is important to understand the concept of forearm pronation and supination in order to understand the following tests.

Supination is the lateral rotation of the forearm and hand. The palm is directed upwards, the thumb outwards. Pronation is the medial rotation of the forearm and hand. In this case, the palm is facing down, the thumb facing in.

• Mills maneuver. The patient remains seated with the arm slightly rotated, the hand extended dorsally and the elbow flexed.
  • The physical therapist places one hand on the elbow and the other on the side of the forearm. The patient is then asked to try to supinate the forearm (twist forearm and hand up) to counter the resistance of the therapist’s hand. If he feels pain while doing this, it is likely that it is a tennis elbow
• Chair test: the patient is asked to lift a chair in two different ways. If he holds it with his pronated hand and the elbow extended, he will feel pain. However, there are no complaints when grasping with the supinated hand.

2. Other tests

If the doctors were unable to diagnose tennis elbow with the previous examination, additional additional tests are carried out:

• Analytical to exclude the presence in the joint of uric acid crystals caused by hyperuricemia.
• Electromyography to rule out nerve compression syndromes.
• Radiology and complementary tests.