了解网球肘

My elbow is killing me today! I often hear this from my patients and friends alike.

Most of them are weekend warriors and active at racquet sports. But it is not only them who complain, a fair share are non-sporting and a good number are homemakers.

Pain over the outer part of the elbow has been called several things. Most people call any pain in the region of the outer elbow Tennis Elbow. This is dangerous as not every painful condition over the outer part of the elbow is – Details of these other conditions at some other time.

Coming back to Tennis Elbow – Mind you, it doesn’t only happen in tennis players! The medical terminology is Lateral Epicondylitis and it is the most common of elbow injuries, typically occurring between the ages of 40 – 60 and affecting up to 3 percent of the population.


What is the Pathological Process?

Tennis elbow occurs when there is damage to the muscle and its tendon over the outer aspect of the elbow. The muscles, which run over the back of the forearm, are mainly attached to the outer part of the elbow. Theses muscles help to extend the wrist and fingers (movements which cause you to curl your wrists upwards and straighten your fingers)

Small tears (micro tears) form in the tendons and muscles, which control the movement of the forearm. These tears happen because the tendons do not stretch. Repeated stress strains the tendon causing it to fray in a similar way that a rope frays. This then causes a restriction of movement, inflammation and pain. As this area is prone to heal poorly with high chance of repeated injury, these micro tears eventually lead to the formation of scar tissue and calcium deposits. This tissue is of poor quality and is prone to further tearing, thus causing persistent pain and dysfunction.


What Causes Tennis Elbow?

The most common cause of tennis elbow is repeated injury due to over use. Any action which places a repetitive and prolonged strain on the forearm muscles, coupled with inadequate rest, will tend to strain and overwork those muscles. Poor technique in sports increases strain on the involved muscles and will contribute to the condition, such as using ill-fitted equipment, like tennis racquets, golf clubs, work tools, etc. It is important to remember that these injuries don’t only occur in those involved in sports. Movements that predisposed to tennis elbow are:

• 弯曲手腕转动肘部，如使用螺丝刀。
• 在旋转手腕的同时用力抓握东西。
• 击打动作，如使用锤子。
• 投掷动作不流畅（生涩）。

还有许多其他原因，如直接损伤--肘部受到碰撞或摔倒。一般体能和调节能力差也会导致这种疾病的发生

体征和症状

疼痛是与网球肘相关的最常见、最明显的症状。疼痛最常发生在前臂外侧，但也可能发生在从肘关节到手腕的任何部位。无力、僵硬和活动受限也是网球肘患者的常见症状。

预防网球肘。

热身： 彻底、正确的热身有助于肌肉和肌腱为接下来的任何活动做好准备。如果没有适当的热身运动，肌肉和肌腱会变得紧绷和僵硬。流向前臂部位的血液将受到限制，从而导致肌肉缺乏氧气和养分。

拉伸： 灵活的肌肉和肌腱对预防大多数拉伤或扭伤极为重要。适当的柔韧度可使肌肉在不过度拉伸的情况下活动和运动。另一方面，紧绷和僵硬的肌肉可能会超出其自然活动范围。

加强： 加强和调节前臂和手腕的肌肉也有助于预防网球肘。

预防外侧上髁炎（网球肘）的拉伸运动 - 这些运动要在有控制的情况下进行。如果运动会带来疼痛或导致更多疼痛，则不应做这些运动。

• Lift your arms to about shoulder height and place your hands together in front of your chest, keeping your fingers together. Your fingers should be just under your chin. Lower your hands towards your waist and stop when you feel a mild stretch. Hold for 20 seconds and repeat 4 times.
• Extend your arm out in front of you, palm down, and push your hand towards you with the other hand until you feel a stretch. Hold for 20 seconds.
• Extend your arm out in front of you, palm up, and push your hand towards you with the other hand until you feel a stretch. Hold for 20 seconds.
• 练习捏网球，握住球几秒钟后再松开。每天做两次。
• 用橡皮筋套住包括拇指在内的所有手指，然后对着橡皮筋练习张开手指。每天做两次。

Treating Tennis Elbow.

The occurrence of acute pain should bring about cessation of the initiating activity.

It is advisable to obtain a consult from an Orthopaedic Surgeon to obtain diagnosis. Not every painful episode over the lateral (outer aspect) of the elbow is due to tennis elbow.

The RICE protocol should be carried out for the first 24-48 hours. This involves R – Rest; I – Ice; C – Compression; E – Elevation. Usage of ice treatment should be done properly for best benefit (Use of Cold and Heat in Injury)

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. This begins with passive methods such as heat and ultrasound therapy and thereafter moves on to the preventive and rehabilitative phase once the pain control is good.

The ultimate aim of this phase is to regain and improve the strength, power, endurance and flexibility of the muscles and tendons that have been compromised.


Dr Harjeet Singh a/l Puran Singh
Consultant Orthopedic Surgeon
Columbia Asia Hospital, Bukit Rimau