Lateral epicondylitis (Tennis elbow)

A quite common overuse injury amongst musicians, especially in pianists that may greatly impact their quality of life. Professional piano playing involves complex movement skills achieved through the repetition of rapid upper-limb motion over longer periods of times. It also comes hand in hand with long hours of static sitting postures, which makes pianists more at risk to develop playing-related muscular disorders and muscle fatigue, which can be detrimental to performance.

Research found that practicing too many hours without break as well as repertoire speed had an impact on the extensor carpi radialis (muscle that extends your hand and flexes the elbow)

Where does it come from?

The main cause of epicondylitis are degenerative changes of the hand and finger extensors due to mechanical overload, neurologic irritation as well as metabolic change. Overuse and/or repetitive microtrauma can lead to an augmented production of fibroblasts (cells that synthesize collagen and build the frame of tissues) leading to a change of the collagen fibers as well as neovascularization.

Risk factors contributing to Epicondylitis

- Trauma

- Smoking

- Age between 45-54

- Obesity

- Practicing over 2 hours a day / one-sided manual acitivities

- Physical exertion

- Depression

- Acute severe pain at the first episode worsen the outcome

What are the signs?

- Tenderness and strained pain at the side of the elbow radiating to the forearm and above the elbow

- May be accompanied by weakness in the wrist

- Local pain while extending and contracting the arm

- The pain can be acute (<6 months) or chronic (>6 months)

What are treatment options?

• Manual techniques like osteopathy: manipulation, manual mobilization techniques can reduce pain and grip strength, helping with getting motion back as well as an adjunction treatment to exercise training

• Specific exercise/resistance training

• Acupuncture

• Shock wave therapy

• Anti-inflammatory drugs can be helpful short-term (up to 6 weeks)

• If no conservative treatment works, surgery might be an option

Sources

Baeyens, Jean-Pierre; Serrien, Ben; Goossens, Maggie; Veekmans, Katia; Baeyens, Regs; Daems, Walter; Cattrysse, Erik; Clijsen, Ron (2020). Effects of Rehearsal Time and Repertoire Speed on Extensor Carpi Radialis EMG in Conservatory Piano Students. Medical Problems of Performing Artists, 35(2), 81–88. doi:10.21091/mppa.2020.2013

Goubault E, Verdugo F, Pelletier J, Traube C, Begon M, Dal Maso F. Exhausting repetitive piano tasks lead to local forearm manifestation of muscle fatigue and negatively affect musical parameters. Sci Rep. 2021 Apr 14;11(1):8117. doi: 10.1038/s41598-021-87403-8. PMID: 33854088; PMCID: PMC8047012.

Tim Leschinger;Thomas Tischer;Anna Katharina Doepfer;Michael Glanzmann;Michael Hackl;Lars Lehmann;Lars Müller;Sven Reuter;Sebastian Siebenlist;Ralf Theermann;Klaus Wörtler;Marc Banerjee; (2021). Epicondylopathia humeri radialis . Zeitschrift für Orthopädie und Unfallchirurgie, (), –. doi:10.1055/a-1340-0931