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Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.

Despite its name, athletes aren’t the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters and butchers.

Tennis elbow is inflammation or, in some cases, microtearing of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to a bony bump on the outside of your elbow. Pain can also spread into your forearm and wrist.

There are many treatment options for tennis elbow. Rest and over-the-counter pain relievers often help relieve tennis elbow. If conservative treatments don’t help or if symptoms are disabling, your doctor might suggest surgery.

Contents

  • Know the Anatomy of elbow
  • What are the symptoms of tennis elbow?
  • When should I see the Doctor?
  • What are the causes of tennis elbow?
  • What are the risk factors?
  • How the diagnosis is made?
  • What are the treatment options available?

Know the Anatomy of elbow

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles, where several muscles of the forearm begin their course. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.

Muscles, ligaments, and tendons hold the elbow joint together.

Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm that are responsible for the extension of your wrist and fingers. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone.  The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).

What are the Symptoms of Tennis Elbow?

The pain associated with tennis elbow may radiate from the outside of your elbow into your forearm and wrist. Pain and weakness may make it difficult to:

  • Shake hands or grip an object
  • Turn a doorknob
  • Hold a coffee cup

When to see a doctor?

Talk to your doctor if self-care steps such as rest, ice and use of over-the-counter pain relievers don’t ease your elbow pain and tenderness.

What are the Causes of Tennis Elbow?

  • Overuse

Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke/backstroke, for example. When the ECRB is weakened from overuse or poor technique, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.

  • Activities

Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle or repetitive extension of the wrist and hand.

Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Auto workers, cooks, repetitive computer mouse use and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.

What are the Risk factors?

  • Age. While tennis elbow affects people of all ages, it’s most common in adults between the ages of 30 and 50.
  • Occupation. People who have jobs that involve repetitive motions of the wrist and arm are more likely to develop tennis elbow. Examples include plumbers, painters, carpenters, butchers and cooks.
  • Certain sports. Participating in racket sports increases your risk of tennis elbow, especially if you employ poor stroke technique.

How the Diagnosis is made?

  1. Medical History. Your doctor may ask some of the following questions:
    • When did your symptoms begin?
    • Does any motion or activity make the pain better or worse?
    • Have you recently injured your elbow?
    • What medications or supplements do you take?
    • Do you have rheumatoid arthritis or a nerve disease?
    • Does your job involve repetitive motions of your wrist or arm?
    • Do you play sports? If so, what types of sports do you play and has your technique ever been evaluated?
  2. Physical Examination. During the physical exam, your doctor may apply pressure to the affected area or ask you to move your elbow, wrist and fingers in various ways.
  3. Imaging. In many cases, your medical history and the physical exam provide enough information for your doctor to make a diagnosis of tennis elbow. But if your doctor suspects that something else may be causing your symptoms, he or she may suggest X-rays or other types of imaging tests (like MRI).

What are the Treatment options available?

Lifestyle and home remedies

Rest. Avoid activities that aggravate your elbow pain.

Pain relievers. Try over-the-counter pain relievers.

Ice. Apply ice or a cold pack for 15 minutes three to four times a day.

Technique. Make sure that you are using proper technique for your activities and avoiding repetitive wrist motions.

Brace. A tennis elbow brace can be used to relieve the pain.

Tennis elbow often gets better on its own. But if over-the-counter pain medications and other self-care measures aren’t helping, your doctor may suggest physical therapy. Severe cases of tennis elbow may require surgery.

Therapy

If your symptoms are related to tennis, your doctor may suggest that experts evaluate your tennis technique or the movements involved with your job tasks to determine the best steps to reduce stress on your injured tissue.

A physical therapist can teach you exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm. Eccentric exercises, which involve lowering your wrist very slowly after raising it, are particularly helpful. A forearm strap or brace may reduce stress on the injured tissue.

Surgical or other procedures:

Injections. Your doctor might suggest injecting platelet-rich plasma, Botox or some form of irritant (prolotherapy) into the painful tendon. Dry needling — in which a needle pierces the damaged tendon in many places — can also be helpful.

Ultrasonic tenotomy (TENEX procedure). In this procedure, under ultrasound guidance, a doctor inserts a special needle through your skin and into the damaged portion of the tendon. Ultrasonic energy vibrates the needle so swiftly that the damaged tissue liquefies and can be suctioned out.

Surgery. If your symptoms haven’t improved after six to 12 months of extensive non-operative treatment, you may be a candidate for surgery to remove damaged tissue. These types of procedures can be performed through a large incision or through several small incisions. Rehabilitation exercises are crucial to recovery