1: A member of your high school tennis team comes to you complaining of an extremely sore elbow, especially on the
outside of her elbow. She just returned from a major tournament where she played a greater number of sets and
matches than she ever had before. On examination you note that she has pain in the region of the lateral humeral
epicondyle that becomes worse immediately after participation. She also states that the pain sometimes radiates into
the muscles on the forearm, specifically the extensor/supinator group. The lateral epicondyle also appears to be
swollen. What would you conclude based on this information? What would you recommend to this athlete?

Tennis elbow is a repetitive strain injury to the extensor muscles and tendons of the forearm. The symptoms of tennis elbow are of pain on the outside of the elbow and back of the forearm, and weakness with grip. A one-handed backhand performed with poor technique is a common cause of tennis elbow (Fig. 1). The one-handed backhand places a lot of strain on the muscles and tendons of the forearm that have a common attachment to the outside of the elbow, called the lateral epicondyle. Initially, pain on the outside of the elbow and back of the forearm will occur when playing tennis. If the injury is not treated appropriately, the symptoms will become more severe and constant, eventually limiting the activity. Repetitive use of a hammer or screwdriver or carrying a heavy briefcase are other potential causes of “tennis elbow.”

Treatment of Birgitte’s tennis elbow condition consisted of specific muscle treatment techniques to free up soft tissue motion of the forearm musculature, chiropractic adjustments to free up joint motion in the wrist and elbow, and ultrasound/electric muscle stimulation combotherapy to decrease pain and restore normal muscle tone. Birgitte was also instructed to ice her elbow 20 minutes on, 1 hour off, and reapply to decrease inflammation.