Tennis Elbow


Tennis Elbow

Tennis elbow, also known as lateral epicondylitis, is a common condition characterized by pain and tenderness on the outside of the elbow. It is caused by overuse and inflammation of the tendon that connects the arm muscles to the bony bump on the outside of the elbow joint (lateral epicondyle). 

Although the name suggests a connection to tennis, tennis elbow can affect anyone who performs repetitive activities that stress the muscles and tendons of the arm. 

In tennis elbow, repetitive motions that stress these tendons, particularly the extensor carpi radialis brevis, cause microtears and inflammation at the tendon’s attachment point on the lateral epicondyle. This inflammation causes pain and tenderness on the outside of the elbow. 

Signs and symptoms of tennis elbow

The most common symptom of tennis elbow is pain near the bony bump (lateral epicondyle) on the outside of the elbow. This pain can be:

  • Sudden, stabbing pain that occurs during activity that strains the tendon. 
  • A dull, throbbing pain that may worsen with activity and persist at rest. 
  • Increased sensitivity to touch in the area of tendon attachment on the lateral epicondyle. 
  • Performing activities that involve grasping or wrist extension, such as opening jars, shaking hands, or picking up objects, may be difficult or painful. 

What are the Causes & Risk Factor?

The main cause of tennis elbow is overuse of the forearm muscles and tendons involved in wrist and finger extension. Activities that can contribute to tennis elbow include:

Predisposing factors for tennis elbow

Although anyone can develop tennis elbow from repetitive activities, certain factors can increase the risk: 

  • Age: As we age, tendons become less flexible and more susceptible to overuse injuries. 
  • Certain sports: Tennis, badminton, squash, and racquetball are common culprits involving repetitive gripping and wrist extension motions. 
  • Occupations: Jobs that require prolonged forceful gripping or wrist extension movements put individuals at higher risk. 
  • Previous elbow injuries: Previous injuries to the elbow joint or tendons can weaken the structure and make them more prone to future overuse injuries. 
  • Poor posture: Round shoulders or other postural imbalances can alter the mechanics and increase stress on the muscles and tendons of the arm. 

Diagnosis of Tennis Elbow

Diagnosing tennis elbow typically involves: 

The healthcare professional will assess the affected elbow for: 

  • Pain and tenderness: They will palpate the outer elbow region to identify the location and severity of pain. 
  • Range of motion: They will assess the range of motion in your wrist and elbow joints. 
  • Strength testing: They will test the strength of your forearm muscles. 

Imaging tests are not usually necessary for diagnosing tennis elbow, but in some cases, X-rays or ultrasounds might be helpful  

  • X-rays: Although X-rays cannot directly see tendon tears, they can be helpful in ruling out other possible causes of elbow pain, such as fractures, arthritis, or bone spurs. 
  • Ultrasound: Although less commonly used, ultrasound can provide detailed images of soft tissues such as tendons and ligaments. This may be helpful in visualizing inflammation or thickening of the tendon at the attachment site on the lateral epicondyle. However, ultrasound findings may not always correlate perfectly with symptoms, and sometimes normal-appearing tendons may be painful. 

In some cases, specific techniques may be used to help confirm the diagnosis:

  • Resisted Wrist Extension Test (Cozen’s Test): The healthcare professional will ask you to extend your wrist while they push down on your hand to resist the movement. Pain on the outer elbow .

Treatment options for tennis elbow

The good news is that tennis elbow usually responds well to conservative treatment. Here’s an overview of common treatment options: 

  • Rest: Avoiding activities that aggravate pain is crucial for early healing. However, full mobilization is not recommended, as gentle movement can help maintain flexibility and prevent stiffness. 
  • Ice therapy: Applying an ice pack to the affected area for 15-20 minutes at a time, several times a day can help reduce pain and inflammation. 
  • Bracing: Wearing a tennis elbow brace can help support the muscles and tendons of the arm, reduce pressure on the affected area, and promote healing. The brace should be placed just below the bony bump on the outer elbow. 
  • Physical therapy: It plays an important role in rehabilitation. Gentle stretching exercises to improve flexibility and range of motion in the arm and wrist.
  • Counterforce brace: This type of brace puts pressure on the muscles of the arm near the wrist, which can help take the stress off the tendon attachment point at the elbow. 
  • Corticosteroid injection: In some cases, injecting corticosteroids directly into the inflamed area can relieve pain. However, repeated injections are not recommended due to possible side effects, such as weakening of the tendon. 
  • Night Splinting: Wearing a splint at night can help keep the wrist in a neutral position and prevent further stress on the tendon during sleep. 

If conservative measures fail to provide adequate relief after several months of treatment, other options may be considered: 

  • Platelet-rich plasma (PRP) therapy: This involves injecting a concentrated solution of the patient’s own platelets into the affected area. PRP contains growth factors that can promote healing. However, research on the effectiveness of PRP for tennis elbow is still ongoing. 
  • Surgery: Surgery for tennis elbow is rarely necessary and is usually only considered in severe cases where conservative treatment has failed and the pain significantly affects daily activities. Surgical procedures may include debridement (removal of inflamed tissue) or repair of any significant tears in the tendon. 

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