Ep 31: Elbow Pain? The Anatomy and Treatment of Tennis Elbow with a Certified Hand Therapist

Got elbow pain? Watch this episode for quick and easy tips you can do at home to help ease joint pain.

Tennis elbow affects the lateral epicondyle on the outside of the elbow, which serves as the anchor point for muscles controlling wrist extension and rotation. Proper understanding of the condition's anatomy and mechanics is essential for effective treatment and preventing further aggravation of symptoms.

• Avoid compression sleeves directly on the elbow as they increase pressure on the painful area
• Use counterforce straps around muscle bellies (not the bone) to redirect pulling forces
• Custom splints can keep wrist extended, putting affected muscles on slack
• Apply gentle stretching 3-4 times daily to maintain muscle length
• Use heat therapy for tight forearm muscles (10-15 minutes, 2-3 times daily)
• Apply ice directly to the bony prominence for short periods to reduce inflammation
• Simple self-test: pain when resisting downward pressure with palm down
• Professional treatments include ultrasound, cold laser therapy, and manual techniques
• Most cases resolve within 4-8 weeks with proper treatment

Chapters

• 0:00 Introduction to Tennis Elbow
• 1:26 Anatomy of Tennis Elbow
• 3:09 What NOT To Do
• 4:31 First Aid for Tennis Elbow
• 7:13 Professional Treatment Options
• 8:26 Self-Testing and Final Advice

Transcript

Speaker 1: 0:00

Welcome back to the Hand-to-Shoulder Solution giving pain the middle finger. I'm Carl Petito, occupational Therapist and Board Certified Hand Therapist. Let's talk about tennis elbow. Do the right thing Now. There's good things to do and of course, there's bad things to do. So if you're wearing something that is hurting you, especially, you know, most importantly, the outside part of the elbow just stop wearing that, especially if it starts chafing you. I've seen people come in wearing all kinds of things compressive sleeves. No one really should wear a compressive sleeve for this. All it does is put pressure on the lateral epicondyle, which is the bony prominence on the outside part of the elbow, and this is a right hand, right here. So on the outside part of the elbow, the humerus comes down. There's a knobby bone that juts out, okay, and that's, and that's right here. That's the anchor point for all of the muscles that do this motion, that motion, and turn your hand palm up, and they're right here. So here's left side, with the skin removed, and you can see all the the red muscles turning into tendons and they're they're anchored back here on the outside part of that elbow. So if you follow your humerus down and you feel that round bony knob, that's what's called the lateral epicondyle e-p-i-c-o-n-d-y-l-e. If you push on that and it's tender, you have what's called lateral epicondyle itis because, remember, itis means inflammation, so that the bone itself is inflamed. And then if you go down toward your wrist and it's tender below that and especially as you start getting into the muscles, most likely have some tendonitis or even some tendinosis, which is some some wearing and fraying of the tendon. There's a lot of different scenarios with tennis elbow and in orthopedics everything has a nickname. The nickname for this is tennis elbow because the backhand, you're using these muscles and when the ball hits it sends a reverberation and it really aggravates this area With a tight grip.

Speaker 1: 2:06

This is interesting. So muscles only pull, they don't push. So with a tight grip you're gripping hard. That's the other side and we're going to talk about golfer's elbow. That's the inside part of the elbow. However, a tight grip will really aggravate the outside part of the elbow because your wrist muscles have to contract and, by the way, your wrist muscles are in the back of your forearm. They have to contract to stop your wrist from bending toward your palm when you make a grip. So when you make a grip, these keep your wrist straight. And guess where they're anchored? They're anchored on the outside part of the elbow, the lateral epicondyle, right here. And you know I don't want to get too caught up in the names of these bony areas, but I just want you to be aware that that bony spot on the outside part of your elbow, that's the anchor point. So when your muscles pull to do an action down here, they can have the action down here lower by your by to move the wrist, because they're anchored right there and that's a lot of pulling stress or tensile stress on that area every time the muscle contracts.

Speaker 1: 3:09

Now one thing we do use for some cases is what's called the counterforce strap. So a strap will go around the muscle bellies. I see people coming into the clinic. They've been wearing it around the bone. It just aggravates the heck out of it. It's the wrong way to use it and it causes the inflammation to be just so much worse. It'd be better to just throw it in the garbage. It's designed to be worn around the muscles so that way, when it's holding the muscle here and the muscle contracts, now more of the pull is coming from here where that strap is, rather than over here at the bone. Another tool we like to use is a custom splint, which I fabricate in the clinic to keep their wrist up a little bit, to keep these muscles on slack. So you can still use your hand, but these muscles are on slack, therefore not pulling so hard on that outside part. But again, we don't want pressure over that. So neoprene, tight sleeves, no, that just doesn't work. And then that also puts pressure on remember previous episodes we talked about the cubital tunnel that pressure on that nerve. You don't want that. So let's say I'll say part of your elbow just starts to hurt, all right, and it hasn't been very long as a few days.

Speaker 1: 4:31

Here's some first aid things you can do. If you, if you reach out like this and you bend your wrist down and that pulls a lot up here and you might maybe have a little discomfort there, that's all right and you can just stretch it lightly. Just lengthen out these muscles. That will restore the length of the muscles and reduce the amount of tension that the tendon is putting on the anchor point in the bone. So some stretching this way and then some stretching this way to stretch the other side as well, because watch this, if the other side is really tight. So now, when you go like this, it's pulling against the other side, it's making these work harder. It's all connected. So if you stretch here, that will help the other side.

Speaker 1: 5:09

So palm up and you're grabbing the palm and the fingers and pushing it down, holding a stretch 20 seconds. You know you're not beating it up, it's just a light, sustained stretch, muscle lengthening, just like when you touch your toes you feel it in your hamstrings and that's just a nice gentle. Pull 20 seconds, relax and then out here like this 20 seconds relax and then waiter's tip. When you turn like this, like a waiter walking away asking for a tip again, there's a nickname for everything in orthopedics you turn it in like this and bend it up. You rotate the shoulder inward and bend that up and you feel a pull up the back of your forearm 10, 10 seconds or so on that one and I would do these three or four times a day.

Speaker 1: 5:51

One or two repetitions, three or four times a day and a heating pad wrapped around the muscles of the forearm. Those muscles get tight. If a muscle's tight and you put cold ice pack on it or put it run under cold running water or something, what's that going to do? Cold shrinks. So the muscle's tight, cold shrinks now. So make the muscle tighter, tighter, tighter, tighter. And then what does that do? It pulls harder on the anchor point. It just makes it worse. So it has to use a low heating pad. 10 to 15 minutes electric heating pad so it's at a low, steady setting. 10 to 15 minutes. Two electric heating pad so it's at a low, steady setting. 10 to 15 minutes. Two to three times a day, not more than three times a day.

Speaker 1: 6:28

All right, now, where it's bony, there's no muscle and you're touching that bone and it hurts, we've got to shrink the inflammation. Shrink the inflammation with cold. What's nice here is to just hold the ice cube with a, with a napkin or something, and put the ice directly on the skin, right on that bony area, only until it's deeply cold. 10 or 15 seconds, 10 or 20 seconds, it doesn't matter the time, just right when it's deeply cold, it's done. And you can do that a couple of times per day, especially, you know, maybe lunchtime, and especially at the end of the day after work. Reduce that inflammation right there.

Speaker 1: 7:00

So the stretching, reducing the inflammation with the cold on that bony prominence, and then using the heating pad around the muscles of the forearm makes all the difference. If you do that for a few weeks and it doesn't go away, you got to go to your doctor and get into your your hand therapist and and then have them take a look at it, do a thorough exam and then get to the bottom of it. There's great tools we have in the office ultrasound, cold laser treatment to penetrate the tissues with an awesome red light that reduces inflammation and at the same time increases blood flow. Manual therapy techniques where I grasp the radius and pull it away from the end of the humerus to relax all of these surrounding musculature and mobilize where the radius and pull it away from the end of the humerus to relax this, all of these surrounding musculature, and mobilize where the radius meets up with the humerus, the upper arm bone, and mobilize the pinky side of the forearm, the ulna, and loosen all that up. It's something that I could do because I have two hands to work on your elbow, whereas you can't do that for yourself at home. So when I have people come into the clinic for this, I'll give them a good kickstart, show them exactly what to do at home, go over the whole program, have them come back in about a week and then after a week have them come back in a week and a half or two weeks. Then after that come back again in two weeks, usually four to six weeks to eight weeks. It back again in two weeks, usually four to six weeks to eight weeks. It fully goes away.

Speaker 1: 8:26

And also we, if you pick the picture, this, this is, this is easy, it's very mechanical. So if you, if you pick something up, palm down in order for it to not fall, these muscles have to contract and hold it up and they're anchored in at that, at that bone. So try it on yourself. If you, if you pick up something, just just push down on yourself like you're holding a, and if that hurts up here on the outside part of your elbow, you probably have tennis elbow. If you flip it over and now resist or pick up something heavy, palm up, that should not hurt you at all. If that doesn't hurt at all, then you go back to this and that hurts, you probably have tennis elbow. And then you try the other things that I showed you. So it's very simple, basic first aid stuff. If it persists, just get into your doctor, into your therapist. Thank you for watching.