The elbow is a joint made up of three bones: the upper arm bone, the humerus, and the two forearm bones, the radius and ulna. The lower end of the humerus has bony bumps on either side called epicondyles that serve as sites of attachment for major tendons and muscles that help in arm movement. The bump on the outside of the elbow is called the lateral epicondyle. It helps in the attachment of the tendons and muscles that help extend your fingers and wrist.
What is Tennis Elbow?
Tennis elbow is a common name for the elbow condition lateral epicondylitis. It is an overuse injury that causes inflammation and microtears of the tendons that attach to the lateral epicondyle.
Tennis elbow is a painful condition occurring from repeated muscle contractions at the forearm. The condition is more common in sports activities such as tennis, painting, hammering, typing, gardening and playing musical instruments.
Tennis elbow and golfer’s elbow are similar, except that golfer’s elbow occurs on the inside of the elbow and tennis elbow occurs on the outside of the elbow. Both conditions are a type of tendinopathy – a combination of inflammation and degeneration of the tendon attachment sites.
Causes of Tennis Elbow
Tennis elbow is usually caused by overuse of the forearm muscles that attach to the lateral epicondyle but may also occasionally be caused by an injury such as a fall, direct trauma to the outside of the elbow, or repetitive trauma for example as part of a work injury.
Tennis elbow is commonly seen in tennis players, hence the name, especially when poor technique is used while hitting the ball with a backhand stroke. Other common causes include any activity that requires repetitive motion of the forearm such as painting, hammering, typing, raking, weaving, gardening, lifting heavy objects and playing musical instruments.
Symptoms of Tennis Elbow
The signs and symptoms of tennis elbow can include the following:
- Lateral elbow pain that gradually worsens over time
- Pain to the outside of the elbow that radiates to the forearm and wrist with grasping objects
- Weak grip
- Painful grip
- Pain that is exacerbated in the elbow when the wrist is bent back
Diagnosis of Tennis Elbow
Your doctor will evaluate tennis elbow by reviewing your medical history, performing a thorough physical examination and ordering X-rays, an ultrasound scan and occasionally an MRI scan. Imaging is usually to exclude other causes of lateral elbow pain and rarely influences treatment decision making.
Treatment of Tennis Elbow
Your doctor will in the first instance almost always recommend conservative treatment options. These may include:
- Limit the use and rest the arm from activities that worsen symptoms.
- Splints or braces may be ordered to decrease stress on the injured tissues.
- Apply ice packs on the elbow to reduce swelling.
- Avoid activities that bring on the symptoms and increase stress on the tendons.
- Anti-inflammatory medications and/or steroid injections may be ordered to treat pain and swelling.
- Physical therapy may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased.
If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend a surgical procedure called lateral epicondyle release surgery. Your surgeon will decide whether to perform your surgery in the traditional open manner (single large incision) or endoscopically (2 to 3 tiny incisions and the use of an endoscope – narrow lighted tube with a camera). Your surgeon will decide which option is best for you depending on your specific circumstances.
Surgery is never a quick fix and recovery can still take 6 months to a year to receive the full benefit of an operation. Surgery is also very much thought of as a last resort because in almost everyone with tennis elbow the condition will eventually get better by itself.