Tennis elbow is a degenerative condition of the tendon fibers that attach on the bony prominence (epicondyle) on the outside (lateral side) of the elbow. The tendons involved are responsible for anchoring the muscles that extend or lift the wrist and hand. Chronic overuse leads to tendon degeneration, which is painful.
Doctors first identified Tennis Elbow (or lateral epicondylitis) more than 100 years ago. Today nearly half of all tennis players will suffer from this disorder at some point. Interestingly though, tennis players actually account for less than 5 percent of all reported cases making the term for this condition something of a misnomer.
Tennis elbow happens mostly in patients between 30 years and 50 years of age. It can occur in any age group. Tennis elbow can affect as many as half of athletes in racquet sports. However, most patients with tennis elbow are not active in racquet sports. Most of the time, there is not a specific traumatic injury before symptoms start.
There are two additional strain related conditions which are often mistaken for Tennis Elbow which are Golfer's Elbow & Bursitis. Tennis Elbow is identified by the onset of pain, on the outside (lateral) of the elbow and is usually gradual with tenderness felt on or below the joint's bony prominence. Movements such as gripping, lifting and carrying tend to be troublesome. Golfer's Elbow has similar causes but pain and tenderness are felt on the inside (medial) of the elbow, on or around the joint's bony prominence. Bursitis of the elbow is often due to excessive leaning on the joint or a direct blow or fall onto the tip of the elbow. A lump can often be seen and the elbow is painful at the back of the joint. Many medical textbooks treat tennis elbow as a form of tendonitis, which is often the case, but if the muscles and bones of the elbow joint are also involved, then the condition is called epicondylitis.
Many individuals with tennis elbow are involved in work or recreational activities that require repetitive and vigorous use of the forearm muscle. Common activities that lead to epicondylitis are both recreational (tennis, especially ground strokes; racquetball; squash; and fencing) and occupational (meat cutting, plumbing, painting, raking, and weaving). Some patients develop tennis elbow without any specific recognizable activity leading to symptoms.
Patients often complain of severe, burning pain on the outside part of the elbow. In most cases, the pain starts in a mild and slow fashion. It gradually worsens over weeks or months.
The pain can be made worse by pressing on the outside part of the elbow or by gripping or lifting objects. Lifting even very light objects (such as a small book or a cup of coffee) can lead to significant discomfort. In more severe cases, pain can occur with simple motion of the elbow joint. Pain can radiate to the forearm.
The damage that tennis elbow incurs consists of tiny tears in a part of the tendon and in muscle coverings. After the initial injury heals, these areas often tear again, which leads to hemorrhaging and the formation of rough, granulated tissue and calcium deposits within the surrounding tissues. Collagen, a protein, leaks out from around the injured areas, causing inflammation. The resulting pressure can cut off the blood flow and pinch the radial nerve, one of the major nerves controlling muscles in the arm and hand.
Tendons, which attach muscles to bones, do not receive the same amount of oxygen and blood that muscles do, so they heal more slowly. In fact, some cases of tennis elbow can last for years, though the inflammation usually subsides in 6 to 12 weeks.
The diagnosis of tennis elbow begins with a complete medical history. X-rays are not necessary. Rarely, magnetic resonance imaging (MRI) scans may be used to show changes in the tendon at the site of attachment onto the bone.
In most cases, nonsurgical treatment should be tried before surgery. Pain relief is the main goal in the first phase of treatment. The best way to relieve tennis elbow is to stop doing anything that irritates the arm — a simple step for the weekend tennis player, but not as easy for the manual laborer, office worker, or professional athlete. The most effective conventional and alternative treatments for tennis elbow have the same basic premise: Rest the arm until the pain disappears, then massage to relieve stress and tension in the muscles, and exercise to strengthen the area and prevent re-injury. If you must go back to whatever caused the problem in the first place, be sure to warm up your arm for at least 5 to 10 minutes with gentle stretching and movement before starting any activity. Take frequent breaks. The patient may need to apply ice to the outside part of the elbow and take acetaminophen or an anti-inflammatory medication for pain relief. Orthotics can help diminish symptoms of tennis elbow which may include counter-force braces and wrist splints. These can reduce symptoms by resting the muscles and tendons. Symptoms should improve significantly within four weeks to six weeks.
If symptoms do not improve, the next step is a corticosteroid injection around the outside of the elbow. This can be very helpful in reducing pain. Corticosteroids are relatively safe medications. Most of their side effects (i.e., further degeneration of the tendon and wasting of the fatty tissue below the skin) occur after multiple injections. Avoid repeated injections (more than two or three in a specific site).
After pain is relieved, the next phase of treatment starts. Modifying activities can help make sure that symptoms do not come back. Physical therapy may help as well. This may include stretching and range of motion exercises and gradual strengthening of the affected muscles and tendons. Physical therapy can help complete recovery and give the patient back a painless and normally functioning elbow. Nonsurgical treatment is successful in approximately 85 percent to 90 percent of patients with tennis elbow.
Surgery is considered only in patients who have incapacitating pain that does not get better after at least six months of nonsurgical treatment. The surgical procedure involves removing diseased tendon tissue and reattaching normal tendon tissue to bone. The procedure is an outpatient surgery, not requiring an overnight stay in the hospital. It can be performed under regional or general anesthesia.
After surgery, the elbow is placed in a small brace and the patient is sent home. About one week later, the sutures and splint are removed. Then exercises are started to stretch the elbow and restore range of motion. Light, gradual strengthening exercises are started two months after surgery. Patients can return to athletic activity usually approximately four months to six months after surgery. Tennis elbow surgery is considered successful in approximately 80 percent of patients.
Even after a patient has resolved their tennis elbow issue, it is important to still pay attention to the use of the arm to avoid reinjury. Always warm up the arm for 5 to 10 minutes before starting any activity involving the elbow. And if severe pain develops after use anyway, pack the arm in ice for 15 to 20 minutes and call your doctor.
To prevent tennis elbow:
- Lift objects with your palm facing your body.
- Try strengthening exercises with hand weights. With your elbow cocked and your palm down, repeatedly bend your wrist. Stop if you feel any pain.
- Stretch relevant muscles before beginning a possibly stressful activity by grasping the top part of your fingers and gently but firmly pulling them back toward your body. Keep your arm fully extended and your palm facing outward.