Tennis Elbow

Written by Maureen Donohue | Published on July 12, 2012
Medically Reviewed by George Krucik, MD

What Is Tennis Elbow?

Tennis elbow, or lateral epicondylitis, is painful inflammation of the elbow joint caused by repetitive stress (overuse). The pain is typically felt on the outside (lateral) part of the upper arm just above the elbow when you straighten or fully extend your arm.

What Causes Tennis Elbow?

Any activity that involves repetitive twisting of the wrist can trigger tennis elbow. This includes tennis and other racquet sports, swimming, golfing, turning a key, or using a screwdriver, hammer, or computer.

The tendon is the part of a muscle that attaches to the bone. Forearm muscles attach to the outer bone of the elbow. Researchers are finding that tennis elbow often occurs when a specific muscle in the forearm—the extensor carpi radialis brevis (ECRB) muscle—is damaged. The ECRB helps stabilize the wrist when the elbow is straight.

Repetitive stress weakens the ECRB muscle, causing microscopic tears in the muscle’s tendon at the point where it attaches to the outside of the elbow. These tears produce inflammation and pain (AAOS).

What Are the Symptoms of Tennis Elbow?

If you have tennis elbow, you may experience one or more of the following symptoms:

  • elbow pain that is mild at first and gradually worsens
  • pain extending from the outside of the elbow down to the forearm and wrist
  • a weak grasp
  • increased pain when shaking hands or squeezing an object
  • pain when lifting something, using tools, opening jars, or using a toothbrush or other utensil

How Is Tennis Elbow Diagnosed?

Tennis elbow is usually diagnosed during a physical exam. Your doctor will ask about your occupation, whether you take part in any sports, and how your symptoms developed.

Then, he or she will perform some simple tests to help make a diagnosis. Tests may include the application of gentle pressure to the spot where the tendon attaches to the bone to check for pain. Your doctor may also have you flex your arm and wrist in a certain way to see if it causes pain.

Your doctor may order imaging tests, such as an X-ray or MRI scan, to rule out other disorders that can cause arm pain. These include arthritis of the elbow and a herniated disk. These tests are not usually necessary to make a diagnosis.

How Is Tennis Elbow Treated?

Nonsurgical Interventions

According to the American Academy of Orthopaedic Surgeons (AAOS), 80 to 95 percent of tennis elbow cases can be successfully treated without surgery (AAOS). Your doctor will first prescribe one or more of the following treatments:

  • Rest: The first step in your recovery is to rest your arm for several weeks. Your doctor may give you a brace to help immobilize the affected muscles.
  • Ice: Ice packs placed over the elbow can help reduce inflammation and relieve pain.
  • Nonsteroidal anti-inflammatory medicines: Over-the-counter medications, such as aspirin and ibuprofen, can help reduce pain and swelling.
  • Physical therapy: Your therapist will use various techniques to strengthen the muscles of your forearm and promote healing. These may include exercises, ice massage, and muscle-stimulating techniques. A newer form of treatment gaining attention is ultrasound therapy. This therapy involves placing an ultrasound probe over the point of greatest muscle tenderness for a prescribed period.
  • Steroid injections: Your doctor may decide to inject a corticosteroid medication directly into the affected muscle to help reduce inflammation.
  • Shock wave therapy: This is an experimental treatment that delivers sound waves to the elbow to promote the body’s own healing process. Your doctor may or may not offer this therapy.

Surgery

If your symptoms have not improved after a year of treatment, you may need surgery. You and your doctor will determine then whether surgery is necessary to improve your condition.

Surgery is either performed arthroscopically, via a small scope inserted into the elbow, or through a larger incision directly over the elbow (open surgery). With either method, the goal is to remove any diseased tissue and to reattach healthy muscle onto the bone.

After surgery, you will need rehabilitation to help restore muscle strength and flexibility.

The AAOS reports that surgery successfully treats tennis elbow in 80 to 90 percent of cases. However, some loss of muscle strength is common (AAOS).

How Can Tennis Elbow Be Prevented?

You can take a number of steps to help prevent tennis elbow, including:

  • making sure you are using the right equipment and proper technique for each sport or task you undertake; for instance, a racquet’s size and how tightly it’s strung can make a difference in causing (or preventing) this condition
  • performing exercises that maintain the strength and flexibility of the arm
  • icing your elbow following strenuous activity
  • resting your elbow if it is painful to bend and/or straighten your arm
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