Tennis elbow, or lateral epicondylitis, is a painful condition that affects the outside or lateral side of the elbow and can cause pain even when gripping or carrying a very light object like a coffee cup. About half of all tennis players will experience tennis elbow at some point in their lives, yet tennis players only account for about 5% of all those who suffer from tennis elbow, as the condition can be brought on by many activities.
Tennis elbow is often confused with two other painful conditions: golfer's elbow or medial epicondylitis, and bursitis. Golfer's elbow is brought about by the same types of activities as tennis elbow, but the pain is primarily felt on the inside of the elbow rather than the outside, while the pain of bursitis is at the back of the elbow.
Tennis elbow will typically cause recurring pain at the outside top of the forearm just below the elbow, and pain may radiate down the arm. Bending the arm, lifting or straightening the arm will also cause pain due to inflamed muscles and tendons. Typical bouts of tennis elbow last 6-12 weeks, but it can also last shorter or longer periods of time.
Tennis elbow is caused by small tears in the muscles of the forearm due to overuse of the muscles or minor injury. It can also occur as the result of a single, forceful injury.
Excessive or repeated use of the muscles that straighten your wrist can injure the tendons in your arm and elbow and lead to tiny tears, which cause rough tissue to form near the bony lump on the outside of your elbow.
Tennis elbow often occurs after you do an activity that uses your forearm muscles when you have not used them much in the past. However, even if you use your forearm muscles frequently, it is still possible to injure them and develop tennis elbow.
As the name suggests, playing tennis — especially repeated use of the backhand stroke with poor technique — is one possible cause of tennis elbow. However, many other common arm motions can cause tennis elbow, including:
Any repetitive motion of the wrist, including tennis, hedge clipping, cutting up cooking ingredients, particularly meat, excessive use of a hammer, screwdriver or computer mouse, painting, or any activity that requires excessive constant gripping or squeezing can cause the condition known as tennis elbow.
In the game of tennis, the following maneuvers can lead to tennis elbow:
One-handed backhand with poor form
A late forehand swing resulting in bending the wrist significantly
Snapping and turning the wrist while serving with full power
The main symptom of tennis
elbow is pain and tenderness on the outside of your elbow. You may
also feel pain travelling down your forearm.
The pain is often
worse when you use your arm and elbow, particularly for twisting
movements. Repetitive wrist movements, such as wrist extension and
repeated gripping, can also make the pain worse.
Tennis elbow
can vary in severity, but you will usually have the symptoms listed
below.
Recurring pain on the outside of your upper forearm, just below the bend of your elbow. Sometimes, you may also feel pain down your forearm towards your wrist.
Pain caused by lifting or bending your arm.
Pain when writing or when gripping small objects. This can make it difficult to hold small items, such as a pen.
Pain when twisting your forearm – for example, when turning a door handle or opening a jar.
Difficulty fully extending your forearm or shake hands.
On average, a typical episode of tennis elbow lasts between six months and two years. Most people (90%) make a full recovery within a year.
The pain of tennis elbow can range from mild discomfort when using your elbow to severe pain that can be felt even when your elbow is still or when you are asleep. You may have stiffness in your arm that gets progressively worse as the damage to your tendon increases.
As your body tries to compensate for the weakness in your elbow, you may also have pain or stiffness in other parts of the affected arm or in your shoulder and neck.
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 doctor 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
Ice the area twice a day for 20 minutes 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 help the healing.
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.
Physical therapy involves different exercises to increase flexibility and strength. These exercises are usually performed at home.
Physiotherapy
If your tennis elbow symptoms are particularly severe or persistent, your doctor may refer you to a physiotherapist (a healthcare professional who is trained to use physical methods, such as massage and manipulation, to promote healing).
A physiotherapist will be able to show you exercises to help stretch and strengthen your forearm muscles. They may also recommend that you wear a splint (an elasticated band that is positioned just below the elbow joint) to help support your elbow and encourage the tendons to heal.
Shock wave therapy
Shock wave therapy is where high-energy sound waves are passed through the skin of the affected area to help relieve the pain of tennis elbow and improve mobility (movement).
Depending on the severity of your pain, shock wave therapy may be given once or it may be repeated. You may have a local anaesthetic during the procedure to prevent you feeling any pain while the shock waves are being passed through your skin.
Your doctor may recommend shock wave therapy if other non-surgical treatments have proved to be ineffective in relieving your symptoms of tennis elbow. Discuss the potential risks, benefits and side effects with your doctor .
Acupuncture
Acupuncture is a type of complementary treatment where fine needles are inserted into the skin around the affected area. In some cases, this may reduce pain and improve movement. However, there is a lack of evidence that it relieves the symptoms of tennis elbow.
A corticosteroid injection may be recommended if you have particularly painful tennis elbow that is making movement difficult. Corticosteroids are a medication that contain steroids (a type of hormone). A corticosteroid injection will reduce the pain in your arm.
Steroid injections can be made into the inflamed area. Although steroid injections are safe, they are usually limited to 2-3 times a year. More 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.
Surgery is usually a last resort but is successful in relieving pain in 85-95% of people.
Surgery 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 in an outpatient procedure taking several hours.
Candidates for surgery are usually those who have had symptoms for more than 6-12 months despite nonsurgical therapies.
Several months of rehabilitation at home in working with a physical therapist are required and begin about 6 weeks after surgery.
As with any surgery, there are risks, which you should talk about with your doctor.
It is often difficult to prevent tennis elbow. However, avoiding putting too much stress on the tendons of your elbow will help you to avoid the condition or to prevent your symptoms from getting worse.
Below are a number of measures that you can take to help prevent tennis elbow developing or prevent it reoccurring.
If you have tennis elbow, stop doing the activity that is causing pain, or find an alternative way of doing it that does not place stress on your tendons.
Rather than using your wrist and elbow more than the rest of your arm, try spreading the load to the larger muscles of your shoulder and upper arm.
If you play a sport that uses repetitive movements, such as tennis, you could get professional advice about your technique so that you do not strain your elbow.
Before playing a sport that involves repetitive arm movements, such as tennis or squash, warm up beforehand and gently stretch your arm muscles to help you avoid injury.
Use lightweight tools or racquets, and enlarge their grip size, to help you avoid putting excess strain on your tendons.
Wear a tennis elbow splint when you are using your arm, and take it off while you are resting or sleeping to help prevent further damage to your tendons. Ask your doctor or physiotherapist for advice about the best type of brace or splint for you to use.
Increasing the strength of your forearm muscles can help prevent tennis elbow. A physiotherapist can advise you about suitable exercises to build up the muscles of your forearm.