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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 boney 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 40 to 50 years of age, but people of any age can be affected.
Tennis elbow is caused by overuse, strain, or injury to the tendon that attaches to the bone on the outside of the elbow (lateral epicondyle). This tendon is attached to the muscle that bends the hand backwards from the wrist. This results in tiny, microscopic tears in the tendon that causes inflammation and pain in the tendon.
Tennis elbow can be caused by any repetitive movements that involves 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 or are using an inappropriate racquet handle size or racquet weight.
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:
- wrist weakness
- hand grip weakness
- pain when the elbow is bent backwards against resistance
- pain in the forearm
- pain when fingers are straightened against resistance
Although there are few complications from tennis elbow, if left untreated, chronic pain can result.
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. Your doctor 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. Your doctor may have you 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 and other tests to rule out other causes of pain.
More than 90% of people respond to conservative treatment. Very few people require s urgery for tennis elbow.
Conservative or non-surgical treatment for tennis elbow involves:
- rest
- ice for 20 minutes up to 6 times daily - do not put ice directly on the skin; put a towel or washcloth between the ice and skin (instead of ice cubes or chips, use frozen peas in a plastic bag)
- anti-inflammatory medications to help relieve pain symptoms
- tennis elbow strap to reduce strain on the tendon
- physiotherapy to reduce pain and inflammation
- a steroid injection into the affected area
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.
Although initially thought to be promising, ultrasound and laser treatments seem to be of questionable benefit.
If conservative treatments have not worked after 6 to 12 months, surgery may be recommended. Surgery is 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 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.
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