Tennis Elbow (Lateral Epicondylitis)

What Is Tennis Elbow?

Tennis elbow is a condition caused by inflammation of the tendons that attach the extensor carpi radialis brevis to the outer bony prominence (lateral epicondyle) of the elbow. Certain repetitive movements of the wrist can cause this condition. Tennis elbow can occur in anyone who strains the tendons of the forearm and is not limited to tennis players. Tennis elbow is also called lateral epicondylitis.

What Causes Tennis Elbow?

  • Any repetitive motion of the wrist, including tennis, hedge clipping, excessive use of a hammer or screwdriver, painting, or any activity that requires excessive constant gripping or squeezing can cause tennis elbow.
  • In the game of tennis, the following maneuvers can lead to tennis elbow:
    • One-handed backhand with poor form or technique
    • A late forehand swing resulting in bending the wrist significantly
    • Snapping and turning the wrist while serving with full power

What Are Tennis Elbow Symptoms and Signs?

  • Tenderness on the outside of the elbow
  • Morning stiffness of the elbow with persistent aching
  • Soreness of the forearm muscles
  • Elbow pain is worse when grasping or holding an object

When Should Someone Seek Medical Care for Tennis Elbow?

Tennis elbow does not usually lead to serious problems. If the condition continues and is left untreated, however, loss of motion or loss of function of the elbow and forearm can develop.

Call your health care professional if the following conditions develop:

  • Pain that limits your daily activity
  • Pain that lasts despite ice, resting, and over-the-counter anti-inflammatory pain relievers
  • Any weakness or numbness in the hand, which may mean you have another type of injury in the wrist or elbow

How Do Health Care Professionals Diagnose Tennis Elbow?

Your doctor may use any or all of the following to diagnose lateral epicondylitis:

  • In taking your medical history, the doctor may ask you questions about your activity level, occupation, recent recreational activities, medications, and other medical problems.
  • During the physical exam, your doctor will feel your elbow and possibly other joints. Your nerves, muscles, bones, and skin are also examined.
  • X-ray images may be required if the symptoms suggest another problem in the elbow joint.
  • Nerve studies may be needed to look for entrapment of the radial nerve in the elbow joint (radial tunnel syndrome) if your symptoms continue despite aggressive treatment.
  • It is unlikely your doctor will need to perform blood tests, a CT scan, or an MRI to make the diagnosis, but these may be used to rule out other conditions in certain cases.

Are There Home Remedies for Tennis Elbow?

  • Home remedies include icing the area for 20 minutes twice a day to help to decrease inflammation and relieve pain. Freezing water in a paper cup and tearing away the top rim as the ice melts is an easy way to use ice. Do not put ice directly on the skin. Wrap it in a towel.
  • Rest the sore area to prevent further injury and decrease pain.
  • Over-the-counter anti-inflammatory medications such as ibuprofen (Advil, Motrin), aspirin, or naproxen (Aleve) may help decrease the pain and swelling and help the healing.

What Are Tennis Elbow Treatments?

Home care with ice, rest, and over-the-counter anti-inflammatory medications are the mainstays of treatment. If these do not produce the desired result, the physician may choose to begin a second line of therapy.

  • An elbow strap or splint may help take the pressure off the inflamed tendon.
  • A physical therapist may have a patient perform different exercises to increase flexibility and strength. These exercises are usually performed at home.

What Medications Treat Tennis Elbow?

Corticosteroid injections can be made into the inflamed area. Although steroid injections are safe, they are usually limited to two to three times a year. Having steroid injections more frequently than that will weaken the tendon and make it more likely to rupture. If positive results are not seen with the first injection, additional injections are also unlikely to work.

A newer treatment involves injecting several milliliters of the patient's own blood into the inflamed tendon area. This is referred to as autologous blood injection. This has been reported to help heal the inflamed tendon faster, and its effectiveness is still being investigated.

When Do Health Care Providers Recommend Surgery for Tennis Elbow?

  • Surgery is usually a last resort but is successful in relieving elbow pain in most people.
  • The operation for lateral epicondylitis involves a small incision over the elbow to trim the tendon or sometimes to release and then reattach the tendon to the bone. It can usually be performed as an outpatient procedure taking several hours.
  • Candidates for surgery are usually those who have had symptoms for more than six to 12 months despite nonsurgical therapies.
  • Several months of rehabilitation at home and working with a physical therapist are required and begin about six weeks after surgery.
  • As with any surgery, there are risks, which you should talk about with your doctor.
Tennis elbow is a common cause of elbow pain.

Causes of Elbow Pain

There are many causes of elbow pain. Most are due to overuse or strain placed on the joint, usually due to work, sports, hobbies, or accidents. Common causes of elbow pain include the following:

  • Sprains and strains: Sprains are stretching and/or tearing of ligaments that connect two bones together, while a strain is a stretching or tearing of the muscle or tendon (a tendon is fibrous tissue that attaches muscle to bone due to excessive force).
  • Tendinitis: Inflammation and/or irritation of the tendons that attach muscles to bones in the elbow is usually due to overuse.
  • Bursitis: Inflammation of the bursae (fluid-filled sac that cushions bones in the elbow)
  • Tennis elbow: Also termed lateral epicondylitis, this is due to tendon inflammation of the muscles of the forearm where they attach to the outer elbow joint.

Tennis Elbow Follow-up

  • Patients should continue the treatment plan for the prescribed length of time. Ending a treatment plan too early increases the chance of reinjury to the tendon.
  • If, after a period of relief, your pain comes back, return to a treatment plan or revisit your doctor.

Is It Possible to Prevent Tennis Elbow?

  • For tennis players:
    • Adjust racquet size: Use a midsized racquet. Oversized racquets can put too much strain on the arm and increase the risk of injury.
    • Loosen string tension: Higher string tension can increase the torque and vibration the arm experiences, thereby increasing the risk of injury.
    • Adjust grip size: A hand grip too small or too large decreases your control of the racquet and increases your risk of injury.
    • Check racquet material: Graphite racquets and nylon strings seem to reduce the torque and vibration the arm receives, thus reducing the risk of a strain injury.
    • Use a tennis elbow strap or tennis elbow brace during play until completely healed.
    • Be careful not to extend the wrist when hitting a backhand.
    • Take a lesson from a tennis professional to improve your technique and explain your difficulties and symptoms.
  • Overall:
    • Ease into any repetitive motion activity around the house and at work and rest at the first sign of pain or soreness.
    • Continue exercises for strength and flexibility even after your pain has gone away before engaging in tennis or other repetitive motion activities.

What Is the Prognosis of Tennis Elbow?

  • A vast majority of people have pain relief within 12 months of conservative therapy (ice, rest, and anti-inflammatory medications).
  • Those who do not get relief with conservative therapy go on to other treatments, also with very high effectiveness.
  • Failure to follow through on a therapy plan frequently leads to recurrence.
Reviewed on 9/11/2017

REFERENCE:

Klippel, J.H., et al. Primer on the Rheumatic Diseases. New York: Springer, 2008.

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