Tennis Elbow

(Lateral Epicondylitis)

The Facts

Tennis elbow, also called lateral epicondylitis, is a very common injury that results from overuse, injury, or strain of the tendon that attaches the forearm muscles to the bony part of the outside of the elbow.

Called "tennis elbow" because tennis players are prone to getting it (50% of tennis players may have this condition), this medical condition is not limited to tennis players. Tennis elbow can occur with any activity that involves repetitive gripping, turning, bending, or extending the wrist backwards.
Tennis elbow mainly affects people between 30 and 50 years of age, but people of any age can be affected.

The Causes

Tennis elbow is caused by overuse, strain, or injury to the lateral epicondyle, which is a tendon that attaches to the bone on the outside of the elbow. This tendon is attached to the muscle that bends the hand backwards from the wrist. This results in microscopic tears in the tendon, causing inflammation and pain in the tendon. This is more likely to develop with weak shoulder and wrist muscles.

Tennis elbow can be caused by any repetitive movements that involve bending the wrist in a turning or backwards motion (e.g., tennis, painting, hammering, using a screwdriver). Pain often comes on gradually but may be sudden such as after lifting a very heavy object. In some cases, no specific cause can be found.

Tennis players are more likely to develop tennis elbow if they have improper technique, have weak shoulder and forearm muscles, frequently hit heavy wet tennis balls, or are using an inappropriate racquet handle size or racquet weight.

Symptoms And Complications

The symptoms of tennis elbow are caused by the inflammation that occurs in the tendon and muscles. The most common symptoms are pain and tenderness on the outside of the elbow. Sometimes, swelling occurs.

Other symptoms include:

pain when the elbow is bent backwards against resistance
pain and weakness in the forearm
pain when fingers are straightened against resistance

The symptoms may last for a few weeks, but some people may have symptoms for months. Although there are few complications from tennis elbow, if left untreated, chronic pain can result.

Making A Diagnosis

If you think you might have tennis elbow, talk to your doctor.

Your doctor will ask you questions about your activities and the type of work you do. They will physically examine your elbow to see if it is tender to touch and to see if the pain you're experiencing worsens when your wrist is bent backwards. You may be asked to perform a chair-raise test, where you will try to lift a chair with your hands on top of the back of the chair.

Your doctor may also put pressure on the muscle a few inches below the elbow bone and test whether you have less pain bending your wrist backwards with this pressure than when there is no pressure.

Your doctor may also examine your neck. Some nerve problems in the neck can cause pain in the elbow similar to that seen with tennis elbow.
Your doctor may also request X-rays, ultrasounds, or other tests to rule out other causes of pain.

Treatment And Prevention

More than 90% of people respond to conservative treatment. Very few people require surgery for tennis elbow.

Conservative or non-surgical treatment for tennis elbow involves:

rest
muscle stretches
tennis elbow strap or braces to reduce strain on the tendon
physiotherapy to reduce pain and inflammation
a steroid injection into the affected area

Although doctors have traditionally used ice and anti-inflammatory medications to treat this condition, newer information suggests that these treatments may not be useful. However, NSAIDs, such as naproxen and ibuprofen, may be able to reduce pain and improve function in the short-term (first 4 weeks). Ultrasound and laser treatments also seem to be of questionable benefit.

Your physician may recommend a steroid injection to relieve pain. The injection provides relief for up to 3 months and is seldom used more than 2 or 3 times per year.

Once pain has stopped or improved, physiotherapy exercises will stretch tightened muscles and strengthen the tendon and muscles in the forearm. Massage may also help.

Some chiropractic techniques, such as manipulation, mobilization, and full kinetic chain therapy with exercise may help recovery and decrease pain associated with tennis elbow.

If conservative treatments have not worked after 6 to 12 months, surgery may be recommended**.** Surgery removes scar and degenerative tissue from the tendons and is about 85% effective for relieving the pain.

Recurrence of tennis elbow can be prevented by using braces to support the wrist, changing technique or equipment, or modifying jobs and activities if possible. Warming up before engaging in sporting activities will help prevent problems, too. Gently stretch the forearm and wrist before performing any sport or activity that can cause or aggravate tennis elbow.