Tennis elbow

Tennis elbow is a condition caused by overuse of the muscles and tendons in the forearm.

Symptoms include pain and swelling on the outside of the elbow. Treatment will include rest and pain relief, and progressive re-strengthening.

The name "tennis elbow" is misleading because the condition is often work-related and sufferers are more likely to be non-tennis players (eg: carpenters, painters, and plumbers). A similar condition affecting the inner part of the elbow is known as golfer's elbow. Both tennis elbow and golfer's elbow are examples of overuse injuries.

Diagram courtesy of www.tennis-elbow.net

Causes

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 at the point where they attach to the bone on the outside of the elbow. The tears cause the tendons and muscles to become inflamed, causing pain.

Activities that can cause tennis elbow include:

• Knitting

• Hammering (eg: in carpentry)

• Tennis (particularly the backhand swing)

• Squash

• Bowling

• Painting.

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.

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 rotating 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 your 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 activities 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 treatments may include:

• Ice

• Physiotherapy/physical therapy

• Acupuncture/acupressure

• Anti-inflammatory medications (eg: ibuprofen)

• A wrist and forearm splint or brace to support and rest the forearm.

Once the 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 to help to reduce inflammation and pain.

If symptoms are still present after approximately 6–12 months of treatment, surgery may be considered. This involves releasing the tension of the tendon and/or removing damaged tendon fibres. Generally, a gradual return to regular activity levels after surgery takes 3–6 months. Rehabilitation exercises are important for recovery.

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

Orthoinfo (2015). Tennis elbow (lateral epicondylitis) (Web Page). Rosemont, IL: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/topic.cfm?topic=A00068 [Accessed: 15/04/20]
Mayo Clinic (2019). Tennis elbow (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/tennis-elbow/home/ovc-20206011 [Accessed: 15/04/20]
Walrod, B.J. (2018). Lateral epicondylitis (Web Page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/96969-overview [Accessed: 15/04/20]

Last Reviewed - April 2020

 

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