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Massage Today
August, 2006, Vol. 06, Issue 08

Tennis Elbow

By Ben Benjamin, PhD

Question: If resisted extension of the wrist causes pain at the elbow, what structure is most likely to be injured?

Answer: The extensor carpi radialis brevis mechanism.

Pain at the outside of the elbow on resisted extension of the wrist is the telltale indicator of tennis elbow.

This injury involves a slight tear or inflammation of either the extensor carpi radialis brevis or the extensor carpi radialis longus. Over 90 percent of the time, it's the brevis that's the culprit. The most common configuration is a V-shaped tear at the tenoperiosteal junction of the brevis tendon, right on the lateral epicondyle of the humerus. To locate this spot, lean sideways against a wall and bend your arm as though you were going to shake hands with someone. The bony protrusion you feel is the lateral epicondyle.

Tennis Elbow tear. - Copyright – Stock Photo / Register Mark Tennis elbows V-shaped tear. In the beginning, pain from tennis elbow is hardly discernible, but it increases significantly after about two weeks. During this time, the tendon has suffered hundreds of microtears with normal activity and/or sports, building a larger, painful, V-shaped scar. Often, individuals suffering from tennis elbow will experience pain on such simple movements as opening a door, shaking hands or combing their hair. They may be unable to carry any item with the affected arm; picking something up can cause such intense, sudden pain that they automatically drop it. Typically, resisted extension of the wrist also is very painful. Do this test gently at first, and increase the force only if no discomfort is felt.

Without treatment, tennis elbow generally lasts a long time, often lingering for a year or two. The V-shaped tear makes healing quite difficult, since the narrower bottom of the V heals more quickly than the top portion. At the top of the tear, the new tissue has a greater distance to span and is therefore weaker. This uneven healing makes a person feel better before the tendon is fully knitted together, so it's easy to re-injure it, which causes scarring.

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