Tennis Elbow (Lateral Epicondylitis)
What is tennis elbow?
"Tennis elbow" is a general term that usually is not related to playing tennis. However, this term came into use because it can be a significant problem for some tennis players who grip their racquet too tightly.
Tennis elbow is a condition usually caused by overuse of the forearm muscles (wrist extenders) that results in pain at the elbow. It affects the outside (lateral) elbow.
Tennis elbow most commonly involves the area where the muscles and tendons of the forearm attach to the outside bony area (called the epicondyle) of the elbow. Your doctor may also call this condition "lateral epicondylitis."
Tennis elbow can affect either the dominant or non-dominant arm, or it may affect both arms.
Who is affected by tennis elbow?
Tennis elbow affects 1% to 3% of the population and, overall, 10% to 50% of tennis players during their careers. Fewer than 5% of tennis elbow diagnoses are related to tennis.
Tennis elbow affects men more than women. It most often affects people between the ages of 30 and 50, although people of any age can be affected.
Tennis elbow also affects other athletes and workers who participate in activities that require repetitive arm, elbow and wrist work. Examples include:
- Baseball players
- Garden and lawn workers
- Jobs that require vacuuming, sweeping, and scrubbing
- Carpenters and mechanics
- Assembly line workers
Symptoms and Causes
What causes tennis elbow?
Tennis elbow is caused by either abrupt or subtle tearing of the muscle/tendon area around the outside of the elbow.
What are the symptoms of tennis elbow?
- Pain generally grows slowly around the outside of the elbow. Less often pain may develop suddenly.
- Pain is worse when shaking hands or squeezing objects.
- Pain is made worse by holding the wrist stiff or moving the wrist with force. Examples include lifting and using tools or even items like a toothbrush or knife and fork.
Diagnosis and Tests
How is tennis elbow diagnosed?
Tennis elbow cannot be diagnosed from blood tests or X-rays. The condition is diagnosed by the description of pain you provide to your doctor (clinical history) and findings during a physical examination. It can be confirmed by ultrasound or MRI.
Since many other conditions can cause pain around the elbow, it is important that you see your doctor so the proper diagnosis can be made. Then your doctor can prescribe the appropriate treatment.
Management and Treatment
How is tennis elbow treated?
Tennis elbow is usually treated by medical means, and only rarely by surgery. The goals of treatment are to:
- Reduce or relieve pain and inflammation (swelling) — This is the first step in the treatment process and may include:
- Resting and avoiding any activity that causes pain to the sore elbow
- Applying ice to the affected area
- Using non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen
- Use of a counter-force brace such as a tennis elbow strap on the forearm for forceful activities
- Use of a wrist splint at night to rest the muscles and tendons
- Using cortisone-type medication, provided by injection into the sore area. This treatment may be needed for severe or prolonged symptoms.
- Allow the injured elbow to recover and heal — This step begins a couple of weeks after pain has been reduced or stopped. The step involves:
- Doing specific physical therapy exercises to stretch out and lengthen and strengthen muscles and tendons near the injured elbow
- Avoiding activities that aggravate pain
- Decrease stress and abuse on the elbow — This part of the treatment process may include:
- Use of the proper equipment in sports and on the job
- Use of the proper technique in sports or on the job
- Use of a counter-force brace, an elastic band that wraps around the forearm just below the injured elbow (tendon), to help relieve pain
- Use of a splint at night to keep your wrist in a neutral position
- More advanced treatments may be appropriate depending on the length and severity of your symptoms and may include use of nitrogen products, PRP (patient's own platelets), shockwave, or even surgery.
The type of treatment will depend on several factors, including the person's age, type of other medications being taken, overall health, medical history, and severity of pain.
Outlook / Prognosis
What is the outlook for people with tennis elbow?
Overall, 90% to 95% of patients with tennis elbow will improve and recover with the treatment plan described previously.
However, about 5% of patients will not get better with "conservative" therapy and will need surgery to repair the injured muscle-tendon unit around the elbow. Eighty percent to 90% of patients who have surgery will improve with pain relief and return of strength to unlimited activities.