What is tennis elbow?

Tennis elbow, or lateral epicondylitis, is a painful inflammation of the elbow joint caused by repetitive stress (overuse). The pain is located on the outside (lateral side) of the elbow, but may radiate down the back of your forearm. You’ll likely feel the pain when you straighten or fully extend your arm.

The tendon is the part of a muscle that attaches to the bone. Forearm tendons attach the forearm muscles to the outer bone of the elbow. Tennis elbow often occurs when a specific muscle in the forearm — the extensor carpi radialis brevis (ECRB) muscle — is damaged. The ECRB helps raise (extend) the wrist.

Repetitive stress weakens the ECRB muscle, causing extremely tiny tears in the muscle’s tendon at the point where it attaches to the outside of the elbow. These tears lead to inflammation and pain.

Tennis elbow can be triggered by any activity that involves repetitive twisting of the wrist. These activities may include:

  • tennis and other racquet sports
  • swimming
  • golfing
  • turning a key
  • frequently using a screwdriver, hammer, or computer

You may experience some of the following symptoms if you have tennis elbow:

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

Tennis elbow is usually diagnosed during a physical exam. Your doctor will ask you about your job, whether you play any sports, and how your symptoms developed. They will then perform some simple tests to help make a diagnosis. Your doctor may apply some pressure to the spot where the tendon attaches to the bone to check for pain. When the elbow is straight and the wrist is flexed (bent toward the palm side), you’ll feel pain along the outer side of the elbow as you extend (straighten) the wrist.

Your doctor may also 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. These tests are not usually necessary to make a diagnosis.

Nonsurgical interventions

About 80 to 95 percent of tennis elbow cases can be successfully treated without surgery. 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: A physical therapist will use various exercises to strengthen the muscles of your forearm and promote healing. These may include arm exercises, ice massage, and muscle-stimulating techniques.
  • Ultrasound therapy: In ultrasound therapy, an ultrasound probe is placed over the most painful area on your arm. The probe emits high-frequency sound waves into the tissues for a set period of time. This type of treatment can help reduce inflammation and speed up recovery.
  • Steroid injections: Your doctor may decide to inject a corticosteroid medication directly into the affected muscle or where the tendon attaches to the bone at the elbow. This can 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.
  • Platelet-rich plasma injection: This is a treatment possibility that seems quite promising and is being used by some physicians. However, it is usually not covered by insurance companies presently.

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Surgery may be needed if symptoms don’t improve after a year of treatment. You and your doctor can determine whether surgery is necessary to improve your condition.

Surgery is either performed through a small scope that’s inserted into the elbow (arthroscopically) or through a larger incision made directly over the elbow (open surgery). Both methods are used to remove any dead tissue and to reattach healthy muscle onto the bone.

After surgery, your arm may be immobilized with a splint. This is done to help restore muscle strength and flexibility.

Surgery successfully treats tennis elbow in 80 to 90 percent of cases. However, it’s common to experience some loss in muscle strength.

There are a number of ways to help prevent tennis elbow, including:

  • making sure you’re using the right equipment and proper technique for each sport or task
  • performing exercises that maintain the strength and flexibility of the forearm
  • icing your elbow following intense physical activity
  • resting your elbow if it’s painful to bend or straighten your arm

If you take these steps and avoid putting strain on the tendons of your elbow, you can lower your chances of getting tennis elbow or prevent it from coming back.