Tennis elbow is also called lateral epicondylitis (inflammation on the outside part of the elbow). This is a painful condition that involves a tendon on the outside part of your elbow.
A tendon starts from bone, turns into muscle, then back to tendon and reattaches to bone at the other end of the muscle.
The tendon involved in tennis elbow is called the ECRB (extensor carpi radialis brevis). Scroll down this page to see a video showing you exactly where this tendon is.
Tennis elbow is a wear and tear degenerative (chronic, age related) tear of the origin of this ECRB tendon.
Tennis elbow pain can occur with lots of different activities like gripping, lifting (light or heavy weight), twisting and even pinching. Golf and tennis can make it worse, but most patients with this condition don’t even play sports regularly.
What causes tennis elbow?
The cause can be both non-work and work related. An activity that places stress on the tendon attachments, increases the stress and strain on the tendon, pulling on this degenerated, abnormal tissue. This creates a pain response in the body.
These stresses can be from holding too large a racquet grip or from “repetitive” gripping and grasping activities, i.e. meat-cutting, plumbing, painting, weaving, etc.
A direct blow to the elbow may result in tearing and swelling of the tendon that can lead to degeneration. A sudden extreme action, force, or activity could also injure the tendon – imagine a huge muscle pulling and contracting so hard that some of the fibers attached to bone start to tear away!
One theory is that the degeneration was happening already, then the traumatic event “turned on” the pain of the tendon problem.
There is a difference between the degeneration process (which happens in everyone as they age) and the pain process, which doesn’t happen in everyone.
Who gets tennis elbow/lateral epicondylitis?
The most common age group for tennis elbow is between 30 to 50 years old, but it may occur in younger and older age groups, and in both men and women.
Signs and symptoms of tennis elbow/lateral epicondylitis
Pain is the primary reason for patients to come to the doctor.
The pain is located over the outside part of the elbow, over the bony part of the elbow called the lateral epicondyle.
This area becomes tender to touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand. This is because the tendon and muscle (ECRB, mentioned above) are attached to both the elbow and the wrist.
The video below shows you exactly where tennis elbow is in the arm.
Sometimes patients are very stiff and painful in the morning. Trying to straigten out the elbow all the way causes pain.
Treatment for tennis elbow
Activity modification – Initially, the activity causing the condition should be limited. Limiting the aggravating activity, not total rest, is recommended. Modifying grips or techniques, such as use of a different size racket and/or use of 2-handed backhands in tennis, may relieve the problem.
A big no-no is lifting palm down – train yourself to lift with the forearm turned palm up. This reduces stress and strain on the ECRB tendon.
Medication – anti-inflammatory medications may help alleviate the pain.
Topical versions of these medications are available and are less harsh on your stomach – ask us in the office if prescribing one is appropriate.
Brace – a tennis elbow brace, a band worn over the muscle of the forearm, just below the elbow, can reduce the tension on the tendon and allow it to heal.
Physical Therapy – may be helpful, providing stretching and/or strengthening exercises. Modalities such as ultrasound or heat treatments may be helpful.
Steroid injections – A steroid is a strong anti-inflammatory medication that can be injected into the area. No more than three injections should be given total.
PRP, or protein-rich plasma, is a concentrated part of your own blood.
Injecting this solution of growth factors and other immune proteins into the painful degenerated tendon can help jumpstart healing and is often more effective than steroid shots.
Surgery is only considered when the pain is incapacitating and has not responded to non-surgical options, and symptoms have lasted more than six months.
Imagine yourself saying, “I’m sick and tired of trying this stuff that hasn’t worked”! – that’s about the right time to think about surgery.
Surgery involves removing the diseased, degenerated tendon tissue. This surgery is performed in the outpatient setting.
Recovery from surgery includes physical therapy to regain motion and strength of the arm. Full recovery can take 4–6 months but normal daily activities are possible at around 6-8 weeks.
Another Tennis Elbow Video from the ASSH (American Society for Surgery of the Hand):