Tennis Elbow

Apr 07, 2023
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Tennis elbow, or lateral epicondylitis, is the most common over use injury of the elbow in ages 30 to 60. It occurs with sports or work activities that require repetitive gripping and lifting. Accurate diagnosis is essential for successful treatment.

What is tennis elbow?

Lateral epicondylitis, commonly known as tennis elbow, is an overuse injury that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm. The repetitive trauma leads to inflammation, degeneration and potential tearing of the tendons.

Who gets tennis elbow?

Despite its name, athletes aren't the only people who develop tennis elbow. Anyone who regularly performs repetitive activities that vigorously use the forearms, wrists or hands can get tennis elbow. 

Tennis elbow can affect recreational and professional athletes:

  • Baseball and softball players.
  • Bowlers.
  • Fencers.
  • Golfers.
  • Tennis, squash, pickleball and racquetball players.

Industrial athletes are also more prone to tennis elbow:

  • Assembly line workers and auto mechanics.
  • Butchers and chefs.
  • Carpenters, cleaners, painters and plumbers.
  • Dentists.
  • Gardeners and landscapers.
  • Manicurists.
  • Musicians.

What causes tennis elbow?

Repetitive contraction of the forearm muscles that you use to straighten and raise your hand and wrist can cause your forearm muscles to get fatigued. The repeated motion stressed the tendons that attach the forearm muscles to the bony prominence at the outside of your elbow (lateral epicondyle). As your muscle gets tired, the tendon takes more of the load which can cause inflammation and pain, known as tendinitis. Over time, this overloading can cause a degenerative condition known as tendinosis. Together tendinitis and tendinosis can then lead to tendon tearing.

As the name suggests, playing tennis — especially repeated use of the backhand stroke with poor technique — is one possible cause of tennis elbow. Sometimes, a sudden arm or elbow injury causes tennis elbow. Rarely do people develop the condition for no known reason (idiopathic tennis elbow).

What are the symptoms of tennis elbow?

Since tennis elbow is usually the result of overuse, symptoms tend to come on slowly. The pain, burning or ache associated with tennis elbow may radiate from the outside of your elbow into your forearm and wrist. Symptoms may get worse over weeks and months. Pain and weakness may make it difficult to:

Signs of tennis elbow include:

  • Pain when shaking hands or gripping an object.
  • Pain when twisting or bending the arm (turn a doorknob or open a jar).
  • Stiffness or pain when extending your arm.
  • Swollen elbow joint that’s tender to touch.
  • Weakened grip when holding items in your hand.

If you continue the activity that caused your condition, the pain may spread down to your wrist, even at rest. Pain may also persist when you place your arm and hand palm-down on a table, and then try to raise your hand against resistance.

How is tennis elbow diagnosed?

A history is obtained to ask about activities that cause pain.  A physical exam is performed to check elbow joint pain, swelling and stiffness. In some cases, you may one or more of certain tests, such as:

  • X-rays to rule out conditions like arthritis or a broken bone.
  • Imaging tests, including ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT) scans, to assess tendon and muscle damage.
  • Electromyography (EMG) checks for compressed nerves, that may be causing your pain, by measuring muscle and nerve electrical activity.

How is tennis elbow treated?

Tennis elbow may get better on its own with little, if any, treatment. However, that recovery may take up to 18 months. Proven nonsurgical techniques exist that can accelerate your recovery. 

Nonsurgical and minimally invasive treatments for tennis elbow include:

  • Rest: You may need to stop or decrease activities for several weeks to give tendons time to heal.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDS, including ibuprofen (Advil®) and naproxen (Aleve®), may ease pain and inflammation.
  • Braces: Your provider may recommend wearing a removable support brace called a counterforce brace. This tool takes tension off of tendons and muscles.
  • Physical therapy: Physical therapy exercises can strengthen forearm muscles and your grip. Massage, ultrasound or other muscle-stimulating techniques may help to reduce pain and improve function.
  • Steroid injections: Injectable corticosteroids temporarily relieve joint pain and inflammation. They may have negative long-term effects due to apoptosis (a form of programmed cellular death).
  • Platelet-rich plasma (PRP) injections: Platelets are the part of the blood that allows the body to clot and initiate a healing response. Platelet-rich plasma is produced by spinning blood in a centrifuge so it separates.  Concentrated platelets are then injected into the injured area under ultrasound guidance.
  • Extracorporeal shock wave therapy: Sound waves can break up scar tissue. Afterward, blood flow to the damaged area improves.
  • Minimally invasive tenotomy: A minimally invasive procedure to remove degenerative tendon tissue. This procedure (called TenJet) uses a needle device with high pressured saline to create suction and hydro-resect the degenerative tendon tissue. This may be an alternative to a larger surgical procedure.

Once you’ve had tennis elbow, you may need to wear a brace to keep symptoms from returning.  It’s important to avoid the movement that caused your injury in the first place.  Keep your arms flexible and strong.  Warm up before exercising or using your arms for sports or other repetitive activities.  If you play a racquet sport, make sure your equipment is right for you.

If pain or trouble moving affects your regular daily activities, if your pain doesn’t get better or it gets worse with treatment, if you see a bulge or lump on your arm.

When is it time to schedule a consultation?

  • If pain or trouble moving affects your regular daily activities.
  • If rest, ice and over-counter medications don’t ease your pain.
  • If your pain gets worse with treatment.
  • If you see a bulge of lump on your arm.

Wondering if you’re a candidate for PRP injections?  To find out more, schedule a free introductory call.