Tennis Elbow

Lateral Epicondylitis (Tennis Elbow)

Lateral epicondylitis (tennis elbow) is the name for a condition in which the muscles at the outer side of the elbow is painful and tender.

The elbow joint is made up of the bone in the upper arm (humerus) and the bones in the lower arm (ulna and radius). The bony bumps at the bottom of the humerus are called the epicondyles. The bump on the outer side of the elbow, to which certain forearm muscles are attached by tendons, is called the lateral epicondyle.

How does it occur?

Tennis elbow results from overusing the muscles in your forearm that straighten and raise your hand and wrist. When these muscles are overused, the tendons are repeatedly tugged at the point of attachment (the lateral epicondyle). As a result, the tendons become inflamed. Repeated, tiny tears in the tendon tissue cause pain. Among the activities that can cause tennis elbow are tennis and other racquet sports, carpentry, machine work, typing, and knitting.

What are the symptoms?

The symptoms of tennis elbow are:

• pain or tenderness on the outer side of the elbow
• pain when you straighten or raise your wrist and hand
• pain made worse by lifting a heavy object
• pain when you make a fist, grip an object, shake hands, or turn door handles
• pain that shoots from the elbow down into the forearm or up into the upper arm.

How is it diagnosed?

Your doctor will ask you about your daily and recreational activities. He or she will examine your elbow and arm and will have you do movements that may cause pain in the outer part of your elbow. Your doctor may order x-rays of the elbow.

How is it treated?

Treatment includes the following:

• Avoid activities that cause the pain to get worse
• Put an ice pack on your elbow for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the pain goes away.
• You can also do ice massage. Massage your elbow with ice by freezing water in a Styrofoam cup. Peel the top of the cup away to expose the ice and hold onto the bottom of the cup while you rub the ice over your elbow for 5 to 10 minutes.
• Do the exercises recommended by your doctor.
• There are some injections that can significantly reduce and/or accelerate the healing process. Your doctor will discuss these options with you.

Your doctor may recommend that you:

• Take medication to reduce inflammation for several weeks.
• Wear a tennis elbow strap. This strap wraps around the forearm below the elbow and may act as a new attachment site for the forearm muscles and keeping them from pulling on the painful epicondyle.

While you are recovering from your injury you will need to avoid repetitive motion of the elbow and to change your sport or activity to one that does not make your condition worse. For example, you may need to run instead of play tennis. If you play tennis, your doctor may advise you to use a tennis racquet with a larger grip. He or she may suggest improvements in the way you hold or swing your racquet.

If ice, rest, anti-inflammatory medication, and an elbow strap do not relieve your symptoms, you may need physical therapy. Also, your doctor may recommend an injection medication around the lateral epicondyle to reduce the inflammation. Rarely, in severe cases, surgery may be recommended. When can I return to my sport or activity?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport or activity will be determined by how soon your elbow recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.

You may return to your sport or activity when your are able to forcefully grip your tennis racquet, bat, or golf club, or do activities such as working at a keyboard without pain in your elbow. In sports such as gymnastics, it is important that you are able to bear weight on your elbow painlessly. It is important that there is no swelling around your injured elbow and that it has regained its normal strength compared to your uninjured elbow. You must have full range of motion of your elbow.

How can I prevent tennis elbow?

To prevent tennis elbow:

• Use proper form during your activities, whether they are sports or job-related. For instance, be sure your tennis stroke is correct and that your tennis racquet has the proper grip size.
• Warm up before playing tennis or doing other activities that involve your elbow or arm muscles. Gently stretch your elbow and arm muscles before and after exercise.
• Ice your elbow after exercise or work.
• In job-related activities, be sure your posture is correct and that the position of your arms during your work doesn't cause overuse of your elbow or arm muscles.