The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.

Common signs and symptoms of tennis elbow include:

•Pain or burning on the outer part of your elbow

•Weak grip strength

The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however both arms can be affected.

Your doctor will consider many factors in making a diagnosis. These include how your symptoms developed, any occupational risk factors, and recreational sports participation.

Your doctor will talk to you about what activities cause symptoms and where on your arm the symptoms occur. Be sure to tell your doctor if you have ever injured your elbow. If you have a history of rheumatoid arthritis or nerve disease, tell your doctor.

During the examination, your doctor will use a variety of tests to pinpoint the diagnosis. For example, your doctor may ask you to try to straighten your wrist and fingers against resistance with your arm fully straight to see if this causes pain. If the tests are positive, it tells your doctor that those muscles may not be healthy.

Approximately 80% to 95% of patients have success with nonsurgical treatment.

The first step toward recovery is to give your arm proper rest. This means that you will have to stop participation in sports or heavy work activities for several weeks.

Wrist stretching exercise with elbow extended. Equipment check. If you participate in a racquet sport, your doctor may encourage you to have your equipment checked for proper fit. Stiffer racquets and looser-strung racquets often can reduce the stress on the forearm, which means that the forearm muscles do not have to work as hard. If you use an oversized racquet, changing to a smaller head may help prevent symptoms from recurring.

Physical therapy. Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.

Brace. Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons.

Counterforce brace. Steroid injections. Steroids, such as cortisone, are very effective anti-inflammatory medicines. Your doctor may decide to inject your damaged muscle with a steroid to relieve your symptoms.

Extracorporeal shock wave therapy. Shock wave therapy sends sound waves to the elbow. These sound waves create “microtrauma” that promote the body’s natural healing processes. Shock wave therapy is considered experimental by many doctors, but some sources show it can be effective.

By far the most common way the wrist is injured is a fall on an outstretched hand. (The same type of force can happen in other ways, such as when you brace your self on the dashboard before an automobile crash.) Whether the wrist is broken or ligaments are injured usually depends on many things, such as how strong your bones are, how the wrist is positioned during the injury, and how much force is involved.

Any kind of injury to the wrist joint can alter how the joint works. After a wrist injury, ligament damage may result in an unstable joint. Any time an injury changes the way the joint moves, even if the change is very subtle, the forces on the articular cartilage increase. It’s just like a machine; if the mechanism is out of balance, it wears out faster. Over many years, this imbalance in joint mechanics can damage the articular cartilage. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint can no longer compensate for the damage, and the wrist begins to hurt.

When an injury occurs, pain and swelling are the main symptoms. The wrist may become discolored and bruised. Doctors refer to this as ecchymosis. The wrist may remain painful for several weeks. There are no specific symptoms that allow your doctor to determine whether a wrist ligament injury has occurred.

Once the initial pain of the injury has subsided, the wrist may remain painful due to the instability of the ligaments. If the ligaments have been damaged and have not healed properly, the bones do not slide against one another correctly as the wrist is moved. This can result in pain and a clicking or snapping sensation as the wrist is used for gripping activities.

In the late stages, the abnormal motion may cause osteoarthritis of the wrist. This condition can cause pain with activity. During activity, the pain usually lessens, but when the activity stops, the pain and stiffness often increase. As the condition worsens, a person may feel pain even when resting. The ability to grip with the hand may be diminished. The pain may interfere with sleep.

The diagnosis of ligament injuries of the wrist begins with a medical history. Your doctor will want to know about any injuries to the wrist, even if they were years ago and healed without much problem.

Your doctor will then physically examine your wrist joint. It may hurt when your doctor moves or probes your sore wrist. But it is important that your doctor sees how your wrist moves, how it is aligned, and exactly where it hurts.

You will need X-rays. X-rays are usually the best way to see what is happening with your bones. After a wrist injury, X-rays can help determine whether a wrist fracture has occurred. X-rays can also help your doctor determine whether certain types of ligament injuries have occurred by looking at how the bones of the wrist line up.

If X-rays do not show enough information, other tests may be ordered to view the ligaments better. In some cases, an arthrogram of the wrist is used. This test requires that dye be injected into one of the small joints of the wrist. Special X-rays are then taken to look for leakage of the dye out of the joint. This may help confirm that the ligaments are torn.

More recently, doctors are also using magnetic resonance imaging (MRI) to look at the wrist ligaments. The MRI machine uses magnetic waves to create pictures that look like slices of the wrist joint. Unlike X-rays, an MRI scan shows the soft tissues such as ligaments quite well and can sometimes confirm the presence of a torn ligament in the wrist.

Finally, for cases in which the diagnosis is still in question, arthroscopy of the wrist joint may be used to determine whether a ligament injury is causing the continued symptoms. The arthroscope is a miniature TV camera that is inserted into the wrist joint to allow the surgeon to see the ligaments that may be torn. In some cases, the arthroscope may also be used to assist with repair of the ligaments at the same time.

The first challenge in treating a ligament injury of the wrist is recognizing that it exists. Many patients fall and injure their wrist and assume they have a sprain. They treat the sprain with rest for a few weeks, and then resume their activities. Many ligament injuries go unrecognized until much later when they cause problems.

The treatment of a ligament injury depends on whether it is an acute injury (just happened within weeks) or a chronic injury (something that happened months ago).

A wrist injury that causes a partial injury to a ligament, a true wrist sprain, may simply be treated with a cast or splint for three to six weeks to allow the ligament to heal.

A sprain occurs when an athlete falls and lands on an outstretched arm, slides into base, or twists a knee with his or her foot planted firmly on the ground. These examples and similar traumatic events cause the ligaments that connect the ends of the bones together to overstretch and tear. This type of ligament injury is called a sprain.

Sprains can range from a minor tear to a complete rupture of the ligamentous tissues. Sprains occur in either the upper or lower joints of the body. The most frequently sprained joint is the ankle. This is probably due to the fact that the ankle supports most of the body’s weight and is involved in many activities. Ankle sprains are the most common type of ligament injury. See Ankle Sprain for more details.

Sprains are usually graded according to the extent of the injury. Grade I and Grade II sprains can usually be treated conservatively with ice, rest, and physical therapy. A grade III sprain can place athletes at higher risk for permanent joint damage and instability. An operation may be necessary to successfully repair a Grade III sprain.

The symptoms of a sprain are typically pain, swelling, and bruising of the affected joint. Symptoms will vary with the intensity of the injury. Serious sprains (Grade III) are ligament tears or ruptures that result in the inability to use the affected joint and may lead to permanent instability. Less serious sprains (Grade I and Grade II) may only cause pain with movement and are usually treated by non-surgical means.

Many sports activities place athletes at risk for sprains. These include football, basketball, baseball, volleyball, and many others. Repetitive activities can also cause a sprain. While not all sprains are caused by sports activity, a few tips can help you avoid a sprain:

Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles. Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, bowling in cricket, pitching in baseball, swimming, kayaking – often put the rotator cuff muscles under a lot of stress.

Problems with the rotator cuff muscles can be classed into two categories – Tears of the tendons/muscles, and inflammation of structures in the joint.

Acute Tear

This tends to happen as a result of a sudden, powerful movement. This might include falling over onto an outstretched hand at speed, making a sudden thrust with the paddle in kayaking, or following a powerful pitch/throw.

The symptoms will usually include:

Sudden, tearing feeling in the shoulder, followed by severe pain through the arm

Limited movement of the shoulder due to pain or muscle spasm

Severe pain for a few days (due to bleeding and muscle spasm) which usually resolves quickly

Specific tenderness (“x marks the spot”) over the point of rupture/tear

If there is a severe tear, you will not be able to abduct your arm (raise it out to the side) without assistance

Chronic Tear

A chronic tear develops over a period of time. They usually occur at or near the tendon, as a result of the tendon rubbing against the overlying bone. This is usually associated with an impingement syndrome.

Usually found on the dominant side

More often an affliction of the 40+ age group

Pain is worse at night, and can affect sleeping

Gradual worsening of pain, eventually some weakness

Eventually unable to abduct arm (lift out to the side) without assistance or do any activities with the arm above the head

Nicole was 13 when she injured her knee the first time, playing soccer in a competitive girls league.

She was 15 when she injured the other knee – less than one minute into her first basketball game after recovering from the earlier injury – and ended her athletic career before it had ever really started.

“My whole life revolved around sports, and then it was over,” said Nicole, who is going through her second round of rehabilitation. “I guess I’ll focus on other things now, like school. I’m trying to make the best of it.”

Children always fall. Hard or repeated falls always compromise free motion of bones and muscles. This is especially important in children, because the bones are growing and, left untreated, these compressed bones grow crooked and tight. Sports injuries can cause the restricted motion of bones and muscles.

Scoliosis can be caused from untreated falls and untreated sports injuries. Hyperextended vertebrae in the mid back result from participating in ballet and gymnastics, later giving rise to chronic back pain. Poor shoulder motion occurs in children who fall on their arms and/or very young children who do flips in gymnastics (gymnastics should not start before the age of 6 or 7 because the ligaments are not strong enough around the bones.)

Knee injuries that result from sports injuries can be treated with osteopathy. Often the fibula (small bone on the outside of the leg) is shoved upward and inward, giving rise to knee pain. If the knee has internal damage, osteopathy will not help.

Headers in soccer should never be done. Hitting the head on a soccer ball always jams up cranial bones. If done repeatedly, or with one hard blow, permanent brain damage has been documented.

It is usually the Rectus abdominus muscle which is damaged in an abdominal strain but other muscles in the stomach area (Internal obliques, External obliques) can be affected. Ruptures occur in weightlifters, throwers, gymnasts, rowers, wrestlers and pole vaulters and other sports which involve fast whole body movements and changes of direction. If the athlete returns to training before the injury is allowed to heal fully then repeated injuries may occur.

Symptoms include:

Tenderness and inflammation over an area of the rectus abdominis (usually at the bottom).

A sudden sharp pain in the abdominal muscles which would indicate a rupture.

An increase in pain when the abdominal muscles are contracted e.g. doing a stomach crunch.

What can the athlete do about it?

Rest until there is no pain.

Use a heat retainer and apply heat for example with a hot water bottle (after the first 48 hours in the case of a suspected rupture).

See sports injury professional who can advise on rehabilitation.

What can a sports injury specialist or doctor do?

Prescribe anti-inflammatory medication e.g. ibuprofen.

Use ultrasound and laser treatment.

Prescribe a full rehabilitation programme to avoid re-injury.

Give you a steroid injection if there is inflammation of the tendon followed by rest for 2 weeks.

Operate if it is bad enough for long enough.

If you rest as soon as there is sign of injury then it should not take more than a couple of weeks to heal. If you have ruptured the muscle the healing time will depend on how bad the strain is.

Achilles tendonitis is often now being referred to as achilles tendinopathy. This is because it is no longer thought to be an inflammatory condition. On investigation, the main finding is usually degenerated tissue with a loss of normal fibre structure.

Achilles tendonitis can be either acute, meaning occurring over a period of a few days, following an increase in training, or chronic which occurs over a longer period of time. In addition to being either chronic or acute, the condition can also be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 4cm above the heel). Healing of the achilles tendon is often slow, due to its poor blood supply.

Symptoms of Achilles Tendonitis

Acute tendonitis:

Gradual onset of pain over a period of days

Pain at the onset of exercise which fades as the exercise progresses.

Pain eases with rest.

Tenderness on palpation.

Chronic achilles tendonitis may follow on from acute tendonitis if it goes untreated or is not allow sufficient rest. Chronic achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often.

Chronic tendonitis:

Gradual onset of pain over a period of weeks, or even months.

Pain with all exercise, which is constant throughout.

Pain in the tendon when walking especially up hill or up stairs.

Pain and stiffness in the Achilles tendon especially in the morning or after rest.

There may be nodules or lumps in the achilles tendon, particularly 2-4cm above the heel.

Tenderness on palpation.

Swelling or thickening over the Achilles tendon.

There may be redness over the skin.

You can sometimes feel a creaking when you press your fingers into the tendon and move the ankle.

Causes of Achilles Tendonitis

Achilles tendonitis is an overuse injury. Too much too soon is the basic cause of overuse injuries, however other factors can contribute to developing the condition.

Increase in activity (either distance, speed or hills).

Less recovery time between activities.

Change of footwear or training surface.

Weak calf muscles.

Decreased range of motion at the ankle joint, usually cause by tight calf muscles.

Running up hills – the achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.

Overpronation or feet which roll in when running can place an increased strain on the achilles tendon. As the foot rolls in (flattens) the lower leg also rotates inwards which places twisting stresses on the tendon.

Wearing high heels constantly shortens the tendon and calf muscles. When exercising in flat running shoes, the tendon is stretched beyond its normal range which places an ‘abnormal’ strain on the tendon.