What is Tennis Elbow?
Tennis elbow is the popular term for the medical diagnosis of epicondylitis
of the elbow. The underlying problem is inflammation of the tendons
(ends of muscles) that attach to either the outside or inside aspects
of the elbow. It is also known as tendinitis. It may be classified as
either lateral (outside) or medial (inside) tennis elbow depending on
which tendons are involved. The term tennis elbow is misleading as it
is also quite common among non-athletes and is often occupationally
related. Patients whose occupations require repetitive and/or stressful
forearm activity are especially at risk. Tendinitis may also result
from a specific trauma to the elbow but at times no inciting event is
Most commonly the inflammation involves the tendons on the outside
of the elbow where they attach to what is known as the lateral epicondyle.
These tendons extend or lift the wrist and fingers upwards. This process
results in tears and microtears within these tendons and is directly
related to activities that stress the wrist and fingers. It is most
commonly seen between the ages of 30 and 50.
Signs and Symptoms of Tennis Elbow
Patients with tennis elbow frequently complain of pain on the outside
of the elbow which is exacerbated with strenuous activities such as
lifting, pushing or carrying. In more severe cases even light activities
of daily living produce discomfort such as shaking hands, turning a
key in a door and hair grooming. The affected muscles span from the
elbow to the wrist; therefore, pain and a sense of weakness may be experienced
down the back of the forearm as well as at the elbow.
How is Tennis Elbow Diagnosed?
The physician's diagnosis of tennis elbow is made by taking a thorough
history, physical examination and plain x-rays. Your doctor will evaluate
the point of maximal tenderness, range of motion and strength of the
elbow, wrist and fingers. Specific maneuvers are performed to duplicate
your symptoms such as lifting your wrist upwards against resistance.
Occasionally, an injection of local anesthetic is employed as a diagnostic
test to evaluate pain relief.
Common Treatments for Tennis Elbow
Tennis elbow usually responds to nonsurgical treatment directed at
relief of pain and inflammation followed by promotion of healing. Treatment
is begun with an initial period of rest aided by a wrist splint to relax
the muscles that move the wrist and fingers. Eliminating the activity
that aggravates the condition is important. Anti-inflammatory medications
and a gentle physical therapy program aimed at stretching and then graduated
strengthening of the hand and forearm muscles may also be beneficial.
If you do not respond to these measures your physician may suggest the
use of local steroid and anesthetic injections in order to alleviate
the pain and eliminate the inflammation. As healing occurs, a forearm
support band can be prescribed for use during the sport or occupational
activity that provokes pain. Also, adjustments in the occupational or
athletic equipment such as changes in racquet size, weight or composition,
technique or environment may be indicated to prevent symptoms from returning.
Surgical treatment is required when patients fail to respond to non-operative
treatment, about 5-10% of cases. The surgery is usually performed on
an outpatient basis and may be under general anesthesia or regional
(limited) anesthesia. It consists of an incision along the epicondyle
with excision and repair of the torn tendon. A splint is required postoperatively
for a few weeks followed by a progressive strengthening exercise program.