Tennis elbow

Tennis elbow is an inflammatory condition that causes pain symptoms to the outside part of the elbow. Tennis elbow can occur at any age but typically occurs in the 30 to 50 years age group. The condition affects both men and women equally.

Treatment is likely to include rest, pain medication and physiotherapy, although in prolonged cases surgery might be considered.

Causes

Tennis elbow (lateral epicondylitis) is an inflammatory condition affecting the lateral epicondyle, on the outside part of the elbow. A similar condition affecting the inner part of the elbow - the medial epicondyle - is known as golfer's elbow (medial epicondylitis).

Tennis elbow
(lateral epicondylitis)

Diagram courtesy of www.tennis-elbow.net

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:

Knitting
Hammering (eg: in carpentry)
Tennis (particularly the backhand swing)
Squash
Bowling
Painting.

Diagram courtesy of www.tennis-elbow.net

Signs and symptoms

Pain around the outer part of the elbow is the most typical symptom of tennis elbow. The pain is often described as “burning” in nature. The elbow may be painful to touch and the pain may radiate down the forearm. The pain often increases with grasping, gripping, or rotation of the wrist and forearm. Straightening and bending the elbow may also cause pain.

The severity of pain can range from a mild discomfort to severe pain that interferes with sleep. The pain tends to start gradually and worsen over a period of weeks or months. When the condition is chronic (long-term), weakness of grip may be experienced.

Diagnosis

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.

Treatment

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:

Ice
Massage
Physiotherapy / physical therapy
Acupuncture/acupressure
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.

Prevention

To prevent the recurrence of tennis elbow, adequate stretching and strengthening of the affected muscles is important. It may also be necessary to modify or correct how activities are performed (eg: correcting an incorrect tennis swing) and to check that equipment is appropriate..

References

American Academy of Orthopaedic Surgeons Orthoinfo (2015). Tennis elbow (lateral epicondylitis) (Web Page). Rosemont, IL: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/topic.cfm?topic=A00068 [Accessed: 27/06/17]
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