Tennis Elbow
Elbow Anatomy
The elbow is a complex hinge joint formed by three bones: the humerus in the upper arm and the radius and ulna in the forearm. At the lower (distal) end of the humerus are two bony prominences called the medial and lateral epicondyles.
These epicondyles serve as important attachment sites for muscles and tendons that control movements of the wrist and hand. The lateral epicondyle, located on the outer side of the elbow, provides attachment for the common extensor tendon, which connects to muscles responsible for extending (straightening) the wrist and fingers.
What Is a Tennis Elbow?
Tennis elbow, medically known as lateral epicondylitis, is an overuse injury that affects the tendons attached to the outer part of the elbow (the lateral epicondyle). It is caused by repeated wrist and forearm movements, leading to small tears and pain in the tendon.
It is common in activities such as tennis, painting, typing, gardening, and other repetitive hand motions.
Tennis elbow affects the outside of the elbow, while golfer’s elbow affects the inside. Both are caused by repetitive stress to the tendons.
Causes of Tennis Elbow
Tennis elbow is usually caused by overuse of the forearm muscles and tendons. Repeated wrist and arm movements can lead to small tears in the tendon attached to the outside of the elbow. It can also result from direct injury, such as a fall or accident.
Although common in tennis players—especially with poor backhand technique—it can also occur with activities that involve repetitive forearm motion, such as painting, hammering, typing, raking, gardening, lifting heavy objects, or playing musical instruments.
Symptoms of Tennis Elbow
Common symptoms of tennis elbow can include the following:
- Elbow pain that gradually worsens
- Pain to the outside of the elbow that radiates to the forearm and wrist with grasping objects
- Weak grip
- Painful grip
- Pain worsens when bending the wrist backward
Diagnosis of Tennis Elbow
Tennis elbow is evaluated through a detailed medical history and a thorough physical examination. Diagnostic imaging, such as X-rays or MRI scans, may be recommended to rule out other potential causes of elbow pain. If nerve involvement is suspected, an electromyogram (EMG) may be performed to assess for nerve compression.
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Tennis Elbow Treatment
Your doctor will first recommend conservative treatment options. These may include:
- Limit the use and rest the arm from activities that worsen symptoms.
- Splints or braces may be ordered to decrease stress on the injured tissues.
- Apply ice packs to the elbow to reduce swelling.
- Avoid activities that bring on the symptoms and increase stress on the tendons.
- Anti-inflammatory medications and/or steroid injections may be ordered to treat pain and swelling.
- Physical therapy may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased.
- Pulsed ultrasound may be used to increase blood flow and promote healing of the injured tendons.
Conservative Treatment Alternative
If non-surgical treatments fail to relieve symptoms after 6 to 12 months, surgical intervention may be considered. A procedure known as lateral epicondyle release surgery may be recommended. The decision to perform the tennis elbow surgery through a traditional open approach or an endoscopic technique using small incisions depends on the surgeon’s assessment.
During the procedure, soft tissues are moved aside to expose the extensor tendon and its attachment at the lateral epicondyle. The tendon is then trimmed or released and may be reattached to the bone. Any scar tissue or bone spurs are removed, and the incision is closed with sutures or surgical tape.
After surgery, physical therapy is typically recommended to restore the range of motion and strengthen the elbow.
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