Tennis elbow is an inflammation of the tendons that join the muscles of the forearm on the outside of the elbow. It often happens as a result of strenuous overuse of the muscles and tendons of the forearm and around the elbow joint.
Tennis elbow is also known as lateral elbow pain or lateral epicondylitis. It is not necessarily related to tennis, but tennis players can develop it, because it stems from excessive or repetitive use.
Tennis elbow is thought to affect between 1 percent and 3 percent of the population in the United States. Only 5 percent of cases are among tennis players. Men are more likely than women to have tennis elbow, and it usually occurs from the age of 30 to 50 years.
Contents of this article:
Causes of tennis elbow
Overuse of the muscles and tendons lead to inflammation and pain in tennis elbow.
Among tennis players, the condition is believed to be caused by the repetitive nature of hitting tennis balls, coupled with poor technique, incorrect racquet, and weakness of the forearm muscles. Repeated and incorrect action leads to tiny tears in the forearm tendon attachment at the elbow.
An incorrect technique can cause the power in the swing of a racquet to rotate through and around the wrist. This creates a movement on the wrist instead of the elbow joint or rotator cuff. It causes pressure on the tendon. This leads to irritation and inflammation.
Tennis elbow is associated with the extension of the fifth digit and of the wrist. This is the kind of movement that allows the person to "snap" or flick the wrist. This sort of movement happens during a racquet swing.
Golfers may develop tennis elbow or golfer's elbow, in which the inside of the arm is affected.
Tennis elbow can also stem from daily activities such as using scissors, cutting meat, gardening, sports that involve lots of throwing, swimming, manual work that involves repetitive turning or lifting of the wrist, such as plumbing, or bricklaying, typing, and racquet sports.
Sometimes, there is no apparent cause.
Most often, the extensor muscles become painful due to tendon breakdown from over-extension. The extensor muscles are those that straighten the wrist.
What are the symptoms of tennis elbow?
The most common symptoms of tennis elbow is recurring pain on the outside of the upper forearm, just below the bend of the elbow. Sometimes, pain may also be felt down the arm towards the wrist.
Pain can occur when the individual lifts or bends the arm, or during basic actions such writing, or when gripping small objects, like a pen.
If pain occurs when twisting the forearm, for example, when turning a door handle, or when extending the forearm fully, this can also can be tennis elbow.
Diagnosing tennis elbow
There is an easy test that a person can do at home to decide whether they have tennis elbow.
This is to stand behind a chair, place the hands on top of the chair back, with the palms down and the elbow straight, and to try to lift the chair.
If this causes pain on the outside of the elbow, it is probably tennis elbow.
An MRI gives a more detailed image than an X-ray, as it includes the soft tissues, muscles, and tendons inside the arm.
Electromyography (EMG) may be used to find out if the nerves are compressed.
Treatment options for tennis elbow
Several layers of treatment can be implemented at home or after consulting a physician.
First, rest is important. The rest allows the tiny tears in the tendon attachment to heal. Tennis players treat more serious cases with ice, anti-inflammatory drugs, soft tissue massage, stretching exercises, and ultrasound therapy.
Racquet sports and other activities that put strain on the forearm can cause tennis elbow.
Stretches and progressive strengthening exercises involving use of weights or elastic bands to increase pain-free grip strength and forearm strength can be helpful.
Physiotherapists commonly advise racquet sports players to strengthen their shoulder rotator cuff, scapulothoracic, and abdominal muscles. This can help to reduce overcompensation in the wrist extensors during gross shoulder and arm movements.
Soft tissue release or massage can help to reduce muscular tightness and decrease the tension on the tendons. Strapping the forearm can help realign the muscle fibers and redistribute the load. A physician may recommend immobilizing the forearm and elbow by using a splint for 2 to 3 weeks.
If symptoms are very painful, and the condition is making movement difficult, a steroid injection may be recommended.
Cortisone is a steroid that can help to reduce inflammation. After a steroid injection, the person should rest the arm and avoid putting too much strain on it too quickly.
Ice massage and muscle stimulating techniques can help the muscles to heal.
Other treatments include injections of botulinum toxin, also known as Botox and extra-corporeal shock wave therapy, a technique that is thought to trigger healing by sending sound waves to the elbow. Heat therapy, low level laser therapy, occupational therapy, and trigger point therapy are other options.
A new type of therapy is an injection of platelet-rich plasma (PRP), prepared from the patient's own blood. PRP contains proteins that encourage healing. The American Academy of Orthopaedic Surgeons (AAOS) describe this treatment as promising but still under investigation.
Between 80 percent and 95 percent of patients recover without surgery, but in the rare cases where nonsurgical treatment does not solve the problem in 6 to 12 months, surgery may be needed to remove the damaged part of the tendon and relieve the pain.
In a discussion published in the Canadian Family Physician, Finestone and Rabinovitch, refer to a number of exercises using dumbbells that have helped with muscle conditioning in patients with tennis elbow. They point out that the patient should "be compliant and have some tolerance for pain."
Preventing tennis elbow
To decrease the likelihood of contracting this injury, it is important to pay attention to techniques of movement.
It is better to spread the load to the larger muscles of the shoulder and upper arm, rather than focusing activity on the wrist and the elbow.
It is essential to warm up before playing a sport that involves repetitive arm movements, such as tennis or squash. Gently stretching the arm muscles will help to avoid injury.
Using lightweight tools or racquets with a larger grip size will help reduce strain on the tendons. Damp tennis balls and older balls load the arm with unnecessary force.
To prevent further damage to the tendons, it may be useful to wearing an arm brace or a wrist splint when using the arm. It can be taken off while resting or sleeping. A physician or physiotherapist can advise about the best type of brace or splint.
Finally, increasing the strength of forearm muscles can help to prevent tennis elbow.
A physiotherapist can also recommend suitable exercises to help build up the appropriate muscles.