Wellness & Lifestyles Australia

TENNIS ELBOW & ELBOW ARTHROSCOPY E-BOOK

prepared by

Wellness & Lifestyles Australia

2007,2008,2009

Table of Contents Page No. IMPORTANT NOTICE ..................................................................................................... 2 

INTRODUCTION .......................................................................................................... 3 

ELBOW ANATOMY ........................................................................................................ 4 

TENNIS ELBOW EXERCISE PROGRAM .................................................................................. 6 

ELBOW ARTHROSCOPY .................................................................................................. 9 

Indications for surgery: ....................................................................................... 9 

The procedure: ................................................................................................ 9 

AFTER YOUR ELBOW ARTHROSCOPY ................................................................................. 10 

Advice and information: ..................................................................................... 10 

REHABILITATION AFTER ELBOW ARTHROSCOPY ................................................................... 11 

SUMMARY ................................................................................................................ 16 

RESOURCES .............................................................................................................. 16 

CONTACT US ............................................................................................................ 17 

MANUAL LAST MODIFIED 15/02/2012

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IMPORTANT NOTICE The information provided in this document can only assist you in the most general way. This document does not replace any statutory requirements under relevant State and Territory legislation. Wellness & Lifestyles Australia (W&L) accepts no liability arising from the use of, or reliance on, the material contained in this document, which is provided on the basis that the Office of W&L is not thereby engaged in rendering professional advice. Before relying on the material, users should carefully make their own assessment as to its accuracy, currency, completeness and relevance for their purposes, and should obtain any appropriate professional advice relevant to their particular circumstances. To the extent that the material in this document includes views or recommendations of third parties, such views or recommendations do not necessarily reflect the views of the Office of W&L or indicate its commitment to a particular course of action. © Copyright Australia 2009 This work is copyright. You may download, display, print and reproduce this material in unaltered form only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart from any use as permitted under the Copyright Act 1968, all other rights are reserved.

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INTRODUCTION Welcome to the W&L series of e-Books. You have chosen the edition on tennis elbow and elbow arthroscopies. This resource will be beneficial to Anyone who is interested in the anatomy and biomechanics of the elbow joint Anyone who suffers from tennis elbow and would like to know how to manage it with exercises Anyone who is wondering what an elbow arthroscopy involves and in what circumstances it is usually

performed Anyone who would like a guide to elbow rehabilitation after surgery The information provided is up to date and follows industry standard. W&L recommend that you continue to consult your doctor and physiotherapist so that your progress can be monitored and program tailored to your specific requirements.

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ELBOW ANATOMY

Diagram taken from:

John R. Schultz, M.D. (2010), Elbow Pain Now Addicted to Narcotics, accessed 02 February 2012 on http://stemcelldoc.wordpress.com/tag/lateral-epicondylitis/

Diagram taken from:

American Academy of Family Physicians, Evaluation of Overuse Elbow Injuries, accessed 02 February 2012 on http://www.aafp.org/afp/2000/0201/p691.html

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The elbow joint is made up of three bones, the humerus in the upper arm and the radius and ulna in the forearm. There are four main movements which occur at the elbow, these are called flexion, extension, supination and pronation. Flexion is when the elbow bends and extension is when the elbow straightens. The way the joint is formed, the elbow should not be able to extend backwards. The movement occurs between the humerus in the upper arm and the ulna in the forearm. Supination and pronation are rotation movements which you can see by bending your elbows and then turning your palms so that they face up then face down. This movement occurs between the radius and the ulna in the forearm. There are many structures in the elbow which help to prevent any other movements (like bending sideways or backwards) as well as important blood vessels and nerves. The tendon involved with tennis elbow (also known as common extensor tendinopathy) attaches at the top of the forearm and is connected to the muscles which work to bend the wrist backwards as well as grip. These muscles work in activities like writing, typing, driving, turning knobs, opening jars or, as the name suggests, many racquet sports. The tendon suffers degeneration from repetitive stress and can develop micro tears which irritate it. The treatment for this condition will be discussed further in the e-book.

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BASIC TENNIS ELBOW EXERCISE PROGRAM Initial management for tennis elbow, also known as extensor tendinosis, is pain control – if the area is swollen and inflamed, ice will be beneficial to control any acute symptoms in your forearm. Otherwise, heat treatment can be beneficial in assisting with pain management and increasing extensibility of soft tissues before a stretching session is commenced. Your physiotherapist will also be able to help manage and contain pain symptoms as well as provide education for self management. Your general practitioner may also recommend medication for pain or swelling. It is always important to have primary and allied health care involved in management of health conditions and injuries to achieve the best possible outcomes. Once pain is controlled, a combination of stretching and strengthening is important to repair the common extensor tendon involved in tennis elbow. The exercises need to be of a particular technique in order to maximise the healing in the tendon. Please follow these instructions to complete exercises properly. Wrist extensor stretch – whilst sitting or standing side on to a flat surface, place the flat of your palm onto the surface, bring your body weight forward as far forward as you can whilst keeping your palm flat.

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Wrist extensor: strengthening – Rest your forearm on a flat surface with hand over the edge (palm facing down). Hold onto a weight and slowly lower your hand, then bend your wrist back up. The slower you are able to lower the weight, the more effective this exercise will be. Do 3 lots of 10 repetitions at a weight and pace which you can complete comfortably without aggravating your elbow.

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Wrist supination/pronation: strength – Rest your forearm and hand on a flat surface. Hold a weight in your hand and alternately tap the palm side and back of your hand. Do 3 lots of 10 repetitions at a weight and pace which you can complete comfortably without aggravating your elbow.

These exercises should be performed twice daily (the stretching can be done throughout the day). Weight should be increased once there is no pain experienced throughout the exercise session. The exercises should be continued for 3 months after symptoms resolve to ensure that the same problem does not reoccur.

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ELBOW ARTHROSCOPY

Indications for surgery: Elbow arthroscopies can be performed in order to examine and repair the elbow joint and surrounding structures. The main scenarios for surgery include: Cleaning out any loose fragments in the joint Smoothing out the joint surfaces Removing bony spurs Loosening the capsule Treating tennis elbow

Arthroscopy for tennis elbow If symptoms are not resolved by a conservative approach (with physiotherapy) then surgery can be an option. In an arthroscopy, the tendon is usually detached and any damaged tissue removed before reattaching the tendon. Rehabilitation exercises will need to be commenced to ensure maximal recovery of function.

The procedure: Arthroscopy involves ‘keyhole surgery’ where a small incision is made and a tiny camera is guided into the elbow where the tissues can be examined and specific surgical treatment can be performed.

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AFTER YOUR ELBOW ARTHROSCOPY

Advice and information: Ask your doctor and surgeon about pain management plans. Once the anaesthetic wears off from the operation and as you are trying to use your elbow more, you may experience an increase in pain. There will be a bandage wrapped around your elbow after surgery. You will also have a sling supporting your arm. Any heavy lifting or leaning through your operated arm should be avoided initially. Follow the RICE regime below to minimise pain, swelling and inflammation.

R Rest: Limit activity levels with consideration to the amount of swelling and pain.

I Ice: Use ice packs or ice wrapped in moistened cloth on your operated elbow for 20 minutes every 2 hours. Continue until the elbow is no longer swollen by the end of the day.

C Compression: Keep tubigrip bandage (like an open sock of bandage) around your elbow until your elbow no longer swells.

E Elevation: Keep the elbow resting so that it is elevated above the level of the heart (preferably) to reduce swelling pooling in the joint.

Icing of the elbow should be performed after exercises in the first couple of weeks after surgery. Commence exercises in accordance with your therapist, making sure that the type and intensity of your exercises are appropriate for the type of surgery you have had.

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REHABILITATION AFTER ELBOW ARTHROSCOPY Perform this program in consultation with a therapist so that they can prescribe these exercises specific to your needs. Do not perform exercises by pushing into pain, slowly build up the exercises. Elbow flexion: range of movement – Bend your elbow slowly so that your hand is moving towards your shoulder. Stop when you start to feel an increase in pain and gently lower back down. Repeat 10 times.

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Elbow extension: range of movement – Straighten your elbow slowly and stop when you start to feel an increase in pain. Gently bend your elbow and repeat 10 times.

Supination: range of movement – Turn your palm up towards the ceiling and stop when you start to feel an increase in pain. Gently relax your elbow and repeat 10 times.

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Pronation: range of movement – Turn your palm so that it is facing down and stop when you start to feel an increase in pain. Gently relax your elbow and repeat 10 times. 

Resisted elbow flexion: strengthening – Attempt to bend your elbow but oppose the movement with your other arm so that the muscles are working but the elbow is not moving. Hold for 3 seconds and repeat 10 times. Alternately, place your bent arm under a table top and try to bend it further, using the table top to resist your movement.

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Resisted elbow extension: strengthening – Attempt to straighten your elbow but oppose the movement with your other arm so that the muscles are working but the elbow is not moving. Hold for 3 seconds and repeat 10 times. Alternately, place your bent arm on top of a table top and attempt to push your hand down (as if straightening your arm). The table top will resist your movement.

Resisted supination: strengthening – Attempt to turn your palm up towards the ceiling but oppose the movement with your other arm so that the muscles are working but the forearm is not moving. Hold for 3 seconds and repeat 10 times.

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Resisted pronation: strengthening – Attempt to turn your palm downwards but oppose the movement with your other arm so that the muscles are working but the forearm is not moving. Hold for 3 seconds and repeat 10 times. 

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SUMMARY In summary, the symptoms of tennis elbow are a result from degeneration of a tendon from repetitive strain. Tennis elbow is usually managed with physiotherapy and exercises but can also be treated with an arthroscopy. Elbow arthroscopies are a relatively non-invasive surgery which can be done to examine and ‘clean up’ the elbow after a variety of injuries, including tennis elbow. After surgery there is a large focus on reducing pain and swelling by using the RICE protocol. Early rehabilitation will gently increase elbow movement and strength but it is important to be sensitive to pain and swelling. Please use this resource as a guide to your rehabilitation in consultation with your surgeon and therapist. All the best for a speedy recovery, The W&L Team

RESOURCES

Sports Med booklets on eccentric program for tennis elbow and elbow arthroscopies were referred to for the content of this e-book.

About.com (2012), http://orthopedics.about.com/

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CONTACT US Wellness & Lifestyles Australia 2/59 Fullarton Road, Kent Town SA 5067 P: +61 8 8331 3000 F: +61 8 8331 3002 E: contact@wellnesslifestyles.com.au W: www.wellnesslifestyles.com.au www.wleducation.com.au W&L services include: Physiotherapy Aged Care Funding Instrument (ACFI) Consultancy Podiatry Speech Pathology Dietetics Diabetes Education Occupational Therapy Psychology Physiotherapy Aide Diversional Therapy Aromatherapy Natural Therapies Massage Exercise Physiology Educational Training Staff Wellness Program Locum Services Medicare Billing Aged Care Funding Instrument Documentation Online Training W&L products include: Posters E-books E-learning modules Audio/visual Hot tips/articles