Tennis Elbow

Tennis elbow refers to an overuse injury to the arm and forearm muscles, manifesting as elbow pain. The term became popular due to its common occurrence in tennis players, but tennis elbow can affect anyone who performs repetitive wrist, arm, or elbow movements. Activities leading to increased risk of developing tennis elbow include working on an assembly line, operating a computer with a mouse, as a mechanic, house cleaner, carpenter, gardener or engaging in sports such as golf, baseball, and bowling.  Most often, tennis elbow occurs in the dominant arm, but the condition can occur in the nondominant arm or both arms. Adults between the ages of 30 and 50 are most likely to suffer from tennis elbow, and men more often than women.

Tennis Elbow Pathology

Referred to as lateral epicondylitis in medical terms, tennis elbow is an overuse injury to the tendons of the forearm muscles where they connect to the bony prominence on the outside of the elbow. Repeated contraction of the forearm muscles performed while moving the hand and wrist results in inflammation of the tendons in the arm. If untreated, tennis elbow can result in micro tears in the tendon and chronic pain. Tennis elbow presents as pain in the outer elbow that may radiate into the forearm and wrist.

The pain and weakness associated with tennis elbow may impair the ability to perform certain actions, such as holding a cup, turning a doorknob, or shaking hands.

Onset of elbow pain may be sudden or late. In sudden onset, a single episode of exertion may cause strain resulting in micro tears in the tendon. Late onset occurs within 24-72 hours of new activity involving wrist extension, such as working on a DIY project at home or using a new racket on the tennis court.

Tennis Elbow Diagnosis

A physician performs a physical exam, asks questions regarding the history and duration of pain, and request the patient move their fingers, elbow, and wrist in various positions. Other conditions may cause elbow pain, and the doctor may seek to rule these out by visualizing the muscles, tissues, and bones of the arm with an X-ray or MRI (magnetic resonance imaging). An Electromyography (EMG) may be performed to check for a pinched nerve. This test involves inserting fine wires into the muscle to monitor electrical impulses during muscle movement.

Tennis Elbow Treatment

The first line of treatment for tennis elbow is rest to allow the strained tendons and muscles to recover. Other interventions to reduce pain and inflammation include:

  • Ice applied to the affected elbow to decrease inflammation and reduce pain.
  • Over-the-counter anti-inflammatory drugs, including ibuprofen, may be taken.
  • To support the tendons and muscles and relieve pain, a counter-force brace may be worn. This is an elastic band wrapped around the arm below the elbow.
  • Ultrasound treatment may be ordered by a specialist to stimulate healing by increasing circulation to the area.
  • Massage therapy may provide pain relief and accelerate healing.
  • Acupuncture for pain relief.
  • The physician may prescribe a steroid injection to the affected elbow to reduce inflammation.

If these non-invasive treatments are not successful in relieving pain and inflammation associated with tennis elbow after a year, then surgical intervention may be considered.

Once the tennis elbow has healed it’s important to prevent recurring injury. The doctor or physical therapist may recommend exercises to strengthen the muscles and increase flexibility of the arm. If the tennis elbow is a sport related injury, an expert should be consulted to evaluate form and technique, for example, evaluating tennis racket grip. If the injury is a result of repetitive action associated with using tools, it’s important to use proper, ergonomic tools to prevent re-injury.