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IMPORTANT NOTICE
The information provided in this document can only assist you in the most general way. This document
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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.
ELBOW ANATOMY
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.
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.
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.
http://www.wellnesslifestyles.com.au Ph: +61 8 8331 3000 Fax: +61 8 8331 3002
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:
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.
R
I
C
E
Rest: Limit activity levels with consideration to the amount of swelling and pain.
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.
Compression: Keep tubigrip bandage (like an open sock of bandage) around your elbow until your
elbow no longer swells.
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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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.
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P: +61 8 8331 3000
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E: contact@wellnesslifestyles.com.au
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