What is Tennis Elbow?

Lateral epicondylitis, often called tennis elbow, happens when the tendons on the outside of the upper forearm are hurt from overuse. Tendons are a tough band of tissue that connect muscle to bone.

The upper arm bone (humerus) has bumps at the elbow. One of these bumps is called an epicondyle. The forearm has two bones, the radius and the ulna. Along with the humerus, these bones form the elbow joint. Muscles, ligaments, and tendons hold the bones in place and are responsible for movement at the elbow.

Repetitive movements (such as playing tennis, painting, or using a computer mouse/keyboard) can cause wear on the tendons. Over time, they can tear. These small tears add up and eventually cause pain in the place where the tendons meet the bone. Sometimes the pain is sudden. Most of the time, it starts as mild irritation and gets worse. The pain can also spread through your forearm to your wrist, making it difficult to do simple tasks, such as hold an item or shake hands.

Anyone who twists their wrist over and over, especially if that twisting requires strength, is at risk for tennis elbow.

It usually affects people between the ages of 35 and 54. Athletes, painters, plumbers, mechanics, and people who use a computer mouse for long periods of time are more likely to get tennis elbow.

Symptoms

The symptoms of tennis elbow include pain on the outside of your elbow, forearm, and sometimes, the wrist.

The pain is often mild at the start. It can get worse, especially without treatment. Usually, there is no specific injury linked to the start of your tennis elbow.

Tennis elbow may make it hard to grasp or hold things. Everyday actions such as shaking hands or turning a knob may be hard to do.

When to See a Doctor

If you have not had these symptoms before or if your pain is sudden and severe, see your doctor.

You might also try self-care at home:

  • Rest the arm for several days, or even weeks. Avoid any activity that aggravates the injury.
  • Place an ice pack wrapped in a towel on the affected area every 15 to 20 minutes over 3 to 4 days to reduce swelling and pain.
  • Take over-the-counter pain relievers, such as ibuprofen, aspirin, or naproxen.

If self-care does not relieve your symptoms, call your doctor.

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Causes

Tennis elbow is caused by overuse of the tendons of the upper forearm. Playing tennis is one way to get tennis elbow, but many people with this condition have jobs or hobbies that require using the forearm in a repetitive way.

Diagnosis and Tests 

To find out what’s causing your pain, a doctor will examine your arm and ask questions about your pain and symptoms. The doctor will check to see if you have pain in your elbow when your wrist is bent back or if some motions make the pain better or worse. To rule out other causes, imaging tests may be recommended.

  • X-rays may be needed to rule out arthritis or a broken bone
  • An Ultrasound can allow your physician to see tears or other signs of damage in the tendon. Ultrasound can be useful in helping decide what treatments are mostly likely to work for your specific source of pain.
  • An MRI (magnetic resonance imaging) scan may be needed to look for a neck problem such as a herniated disk
  • An EMG (electromyography) test may be needed to rule out nerve compression.

Treatments & Prevention

Treatments

Self-care

The first thing to do is stop any sports or other activities that cause your elbow and arm pain. You can treat your tennis elbow at home using the RICE method. RICE stands for:

  • Rest. Avoid putting weight on the injured elbow, and avoid participating in normal activities until your arm feels better.
  • Ice. Use an ice pack (you can also use a bag of frozen vegetables if you do not have an ice pack) for 15-20 minutes, 3 to 4 times a day to reduce pain and inflammation in the tendon.
  • Compression. A compression bandage or compression brace can be used to support the elbow and reduce swelling.
  • Elevation. To keep swelling down, elevate (raise) your elbow above the level of your heart. You can do this by sitting or lying down on a couch or floor and placing pillows under your arm and elbow until your elbow is higher than your chest.

Consider changing the way you do whichever activity is causing your tennis elbow so that it doesn’t hurt your arm. At work, this might mean changing your chair, desk, or computer setup. For sports, you could play less often or change the equipment you use. Ask your doctor for specific ideas or a referral to a sports medicine specialist.

Physical therapy

Your physician, an athletic trainer, or a physical therapist can teach your how to stretch your arm and build muscle that will ease the strain on your elbow.

Non-surgical procedures

Injections of cortisone are no longer recommended for this condition. While they may help pain in the short term, the long term risk of chronic pain and recurrent symptoms is much higher in patients receiving cortisone or steroid injections. Your physician may recommend non-steroid injections, such as platelet rich plasma, to speed the healing of injured tissues.

Surgery

Surgery might be recommended if other treatments do not relieve the injury.

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