What is a tennis elbow or golfer's elbow?Usually, a tennis elbow or golfer's elbow occurs gradually or sometimes after an accident (tendon tear). By repeated overload, small cracks in the attachment of the muscle to the bone appear. In the tennis elbow, this is on the outside of the elbow and it concerns the extensor muscles of the wrist. Whereby with the golfer's elbow, it is on the inside of the elbow and concerns the flexor muscles of the wrist. Tennis elbow occurs in one to three in every hundred adults. In half of the cases, the tennis elbow heals naturally over the course of several weeks to months. In the other half of the cases, treatment is necessary. A golfer's elbow is seven times less common. The onset and course of a golfer's elbow is virtually identical to that of tennis elbow.
History of tennis elbowThere are generally two reasons to be distinguished:
1Short-term overload on the forearm muscles (hand extensors)
Although in the literature often a big "powerful" overload is seen as the cause of tennis elbow, this is rarely true. Yet it is possible that an unusual load may ultimately be the cause for a tennis elbow. The asymptomatic tennis elbow becomes symptomatic. This phenomenon is based on the fact that in the tendon and muscle tissue small cracks appear (microtraumata of collagen fibers) which are quite harmless and painless. However, the healing process with connective and reactive cells (inflammation) progresses on a microscopic scale. The elastic structures in muscle and tendon tissue will give way to the more rigid, inflexible tissue. Hereby, in our opinion, the sensory informative components (the information the muscles and tendons given to the brain via sensors located in muscle and tendon) are also affected and give false information to the brain. What fires together, wires together. The brain responds in turn with an abnormal response error and give muscles an overflow of impulses (the muscle is stimulated to increased tension during its actual state of rest). The vicious circle is put into motion and ultimately the muscle will be in condition 2. The tendon attachment is painful due to various processes that initiate the pain being put into motion in and around the tendon. A tennis elbow was born.
22. Prolonged (relatively) small taxation of the forearm muscles (hand extensors)
The tennis elbow does not arise overnight The tendon structure of most patients was probably not optimal. Usually, there are months in advance of repetitions of sustained light continuous taxation. As a result of the forced use of these muscles, changes occur in the muscle and tendon tissue that negatively affect the normal function of these structures. The muscle fibers (cells) and inter-muscular connections, loose connective tissue and fascia structure change such that so-called. "Fibrosis" occurs. Although the name fibrosis (connective) is not correct, we can conclude that the cell is trying to adapt to the job that is expected of these muscles and tendons. In other words it is expected of these muscles that they deliver a sustained slight contraction, while the muscles are not made for it. This is ultimately detrimental to the muscle and tendon tissue, because tightening is not followed by relaxation. We can see also that changes in the structure of the tendon tissue arise. Therefore, we find with the tennis elbow the typical larger base-resting-tension of the forearm muscles. It is as if the muscles are constantly in a slight state of contraction. The muscle and tendon tissue is of a poorer quality and therefore fibrosis and degradation (degeneration) are encouraged. The tendon gets, for too long, to process a slight pull and eventually a slight "inflammation" will show. In the medical world, we speak of a tendinitis. This phase lasts only a few weeks and then goes into the tendinosis phase. A tendinosis, which is a tennis elbow, a tendon degeneration without inflammation and clinical symptoms. The three fundamental properties of a tendinosis are:
- enlarged fibroblasts
- abnormal collagen production..
Upon further investigation, one can see an increased ingrowth of blood vessels and nerve endings, and there is an increased concentration of pain mediators. This explains why "tendinotische 'tendons are painful. The orientation of the collagen fiber structure is muddled. There is an increase of matrix (ground substance) between the fibers through which they are pushed apart and the tendon becomes somewhat thicker.