(Tennis Elbow)
Definition
Definition
Lateral epicondylitis is pain at the elbow. The pain occurs over the bone on the outside of the elbow. There are several muscles and tendons that attach on this area of the bone.
This condition is often called tennis elbow, but it is not restricted to people who play tennis. It can also occur in people with jobs that require repetitive motions such as roofers and carpenters.
Lateral EpicondylitisCopyright © Nucleus Medical Media, Inc.
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Causes
Causes
Lateral epicondylitis is caused by damage to a tendon.
Tendons connects muscles to bone. Repetitive or stressful movements of the muscles causes strain and pain at the tendon. The tendons associated with lateral epicondylitis are connected to forearm muscles. These muscles are active when you grip something, such as a tennis racquet. Actions that can cause irritation to the tendons of the elbow include:
- Improper technique for hitting a tennis ball
- Improper size of tennis racquet or tension of racquet strings
- Improper golf swing technique or grip of golf clubs
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Doing certain arm motions too much, such as:
- Tennis strokes
- Golf swings
- Painting
- Raking
- Pitching
- Rowing
- Using a hammer or screwdriver
Risk Factors
Risk Factors
Factors that increase your risk of lateral epicondylitis include:
- Playing tennis or golf
- Work that requires repetitive wrist extension and gripping with a closed fist
- Muscle imbalance
- Decreased flexibility
- Advancing age
Symptoms
Symptoms
Lateral epicondylitis may develop slowly over time. It may not be associated with a sudden injury. Symptoms include:
- Pain and tenderness on the outside of the elbow
- Possibly pain extending down the forearm
- Tightness of forearm muscles
- Stiffness or trouble moving the elbow or wrist
- Lack of full elbow extension
Pain may be most noticeable when doing activities like:
- Shaking hands
- Turning doorknobs
- Picking up objects with your palm down
- Hitting a backhand in tennis
- Swinging a golf club
- Pressing on the outside of the elbow
Diagnosis
Diagnosis
The doctor will ask about your symptoms and medical history. You may also be asked about your recent physical activity.
The doctor will examine your elbow for:
-
Pain on the outside of the elbow when:
- Doing certain arm motions
- Pressure is applied on the outside of the elbow
- Stiffness of elbow and wrist movement
X-rays are not usually necessary. However, an x-ray may be needed if the doctor suspects other problems.
Treatment
Treatment
Treatment includes:
Rest
Avoid activities that cause pain. Do not play sports or do repetitive motions until the pain is gone. You may need to alter how you do certain activities:
- When lifting objects, lift with your palms up
- Consult a sports professional to check your form when playing tennis or golf
Ice
Regular ice application may help decrease some discomfort and swelling.
Physical Therapy
You may be referred to a physical therapist. You will learn exercises that may help reduce your symptoms and maintain strength.
Medication
The following medication may help reduce swelling in the tendon and pain:
- Nonsteroid anti-inflammatory drugs (NSAIDs)
- Acetaminophen
- Topical pain relievers that are applied to the skin
If medication does not decrease your pain, do not return to physical activity. Check with your doctor.
Compression
Certain injuries may require a brace. It is placed on your forearm. This brace limits the force of your forearm muscles on the tendon.
Cortisone Injection
The doctor may inject cortisone into the tendon. This may help to reduce pain and inflammation in the short term. Unfortunately, the injection may not help in the long run.
When You Are Ready to Return to Exercise
- Heat may be helpful when you are ready to return to physical activity. It can decrease the stiffness in the muscle or tendon.
- Start gentle stretching of the wrist and elbow. Follow your doctor’s recommendations. Do not push the stretch to the point of pain. Hold each stretch for about 10 seconds and repeat 6 times.
- Maintain strengthening exercises for your forearm muscles.
- Gradually return to your sport. Talk to a sports professional to adjust your technique, if needed.
Prevention
Prevention
To help reduce your chance of lateral epicondylitis:
- Keep your arm muscles strong. This will decrease the stress on the tendons.
- After a short warm-up period, stretch out your arm muscles.
- Learn the proper technique for activities that require forearm motion.
-
If you play tennis, ask a tennis specialist to check your:
- Technique for hitting the ball, especially your backhand
- Racket size, tension of racket strings, and composition of the racquet frame
RESOURCES:
Sports Med—American Orthopaedic Society for Sports Medicine http://www.sportsmed.org/Patient
CANADIAN RESOURCES:
Canadian Orthopaedic Foundation http://www.canorth.org
References:
Józsa LG, Kannus P. Human tendons. Human Kinetics; 1997.
Lateral epicondylitis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated March 4, 2013. Accessed March 6, 2013.
Nirschl RP, Kraushaar BS. Keeping tennis elbow at arm’s length. Phys Sportsmed. 1996.
Nirschl RP, Kraushaur BS. Assessment and treatment guidelines for elbow injuries. Phys Sportsmed. 1996;24.
Tennis elbow (lateral epicondylitis). American Academy of Orthopaedic Surgeons Ortho Info website. Available at:
http://orthoinfo.aaos.org/topic.cfm?topic=A00068
Updated September 2009. Accessed November 7, 2012.
11/8/2006 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed
: Bisset L, Beller E, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial. BMJ. 2006;333:939.
10/26/2010 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Massey T, Derry S, et al. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.
Last Updated: 12/20/2014