The epicondyles are the bony lumps that can be felt on either side of the elbow joint. Muscles that enable the wrist and hand to bend back (extend) are attached to the lateral epicondyle by strong tendons. Although lateral epicondylitis is known as tennis elbow, the term is a misnomer as sufferers are more likely to be non-players.
Any repetitive activity that places strain on the muscles of the forearm (particularly the outer muscles) can cause small tears to develop in the tendon fibres. These tears occur at the point where the tendon attaches to the bone and occasionally in the covering of the bone (the periosteum). The tears cause the tendons and muscles to become inflamed, producing pain. Activities that can cause tennis elbow include:
- Hammering (eg: in carpentry)
- Tennis (particularly the backhand swing)
Signs and symptoms
During a physical examination the doctor will try to reproduce the pain in the elbow through specific movements. They may also assess the range of motion in the wrist, elbow and shoulder joints. X-rays and ultrasound scanning may also be recommended to assist in diagnosis and to rule out other possible causes for the pain.
In most cases of tennis elbow a combination of non-surgical treatments is effective. Painful activity should be avoided and the elbow should be rested. It is important, however, that gentle movement of the elbow and forearm through the full range of motion is maintained. Other initial treatment may include:
- Physiotherapy / physical therapy
- Anti-inflammatory medications (eg: ibuprofen, naproxen)
- A specific wrist and forearm splint or brace may be recommended to support and rest the forearm.
When elbow pain reduces, the muscles surrounding the joint should be stretched and strengthened. A physiotherapist / physical therapist can advise on specific exercises to do this. If pain is still present after six to eight weeks of treatment the doctor may recommend a cortisone injection into the affected area.
Cortisone is a corticosteroid medication that can help to reduce inflammation and pain. If, after approximately 6-12 months of conservative treatment the condition is still problematic, surgery may be recommended. This commonly involves releasing the tension of the tendon and/or removing damaged tendon fibres. Generally, a graduated return to regular activity levels after surgery takes 3-6 months.
Mayo Clinic (2016). Tennis elbow (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/tennis-elbow/home/ovc-20206011 [Accessed: 27/06/17]
Walrod, B.J. (2016). Lateral epicondylitis (Web Page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/96969-overview [Accessed: 27/06/17]
Last Reviewed - June 2017