Extensor Tendinopathy

(Lateral Epicondylitis / Tennis Elbow)

What is "extensor tendinopathy"?

Tendinopathy refers to a non-inflammatory degenerative change that occurs in tendons, near their attachment to bone. It is a result of “overuse”, complicating risk factors relating to you and/or the activities you have been involved in. If you have been playing sport, involving the upper body, it is likely this is a factor too.

The outcome is that the tendon has weakened, making it more prone to further injury. This viscous cycle needs to be broken, by preventing injury, addressing the factors that are contributing to the problem and working on strengthening the affected tendon.

The tendon affected is almost always extensor carpi radialis brevis (ECRB), which attaches to the back of the hand, and extends the wrist.

Only 5% of people presenting with this condition play tennis! In tennis players it is the backhand stroke that is classically responsible.

As this is a non-inflammatory condition, it is not surprising that anti-inflammatories do not change the long-term outcome of the condition.

What factors make me more prone to this condition?

Extensor tendinopathy is commonly seen in office workers, manual labourers and sportspeople. In the office using a mouse and typing are contributing factors. In this setting it is important to address posture and ergonomics.

Correct technique is important in all settings. Wherever possible, the extensor muscles of the forearm should not be used in isolation. That is, use of the shoulder and spine should be incorporated into actions as these are much stronger.

Often tightness in the neck and shoulder accompany this condition, placing additional demands on the elbow region to accomplish tasks. Furthermore, nerve tightness and entrapment can be a source of pain around the elbow.

What treatments have been shown may improve this condition?

1. Reduce the pain of tendinopathy
   
   • Local treatment such as ice massage
     
   • Paracetamol
     
   • Corticosteroid injection (will not change the long term outcome)
   
   
2. Reduce the load on the tendon to help with healing
   
   • Relative rest: Modify activities (cease or reduce)
     
   • Elbow brace: Fit just below the tender spot and wear whenever using the elbow
   
   
3. Assist the healing process
   
   • Nitrate patch: 1/4 of a "Nitrodur" placed on tendor spot and changed after 24 hours. May experience headache and/or dizziness.
     
   • Fine needling: Very small needle to stimulate tendon
     
   • Blood injection: Inject blood at the tender area to stimulate healing. Evidence for this technology is still limited.
   
   
4. Strengthen ECRB tendon
   
   • Eccentric loading program: This is a muscle tendon loading program that involves loading the tendon as it lengthens. It is a 12 week program of 3 sessions a day, 3 sets per session. There is an increase in intensity and repetitions at regular intervals.