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Tennis
elbow
Tennis elbow is one of several overuse
injuries that can affect your elbow. Other similar conditions include golfer's
elbow and little leaguer's elbow — but they involve a different part of your
elbow.
The pain of tennis elbow occurs primarily
where the tendons of your forearm muscles attach to the bony prominence on the
outside of your elbow (lateral epicondyle). Pain can also spread (radiate) into
your forearm and wrist. Another name for tennis elbow is lateral
epicondylitis. The bony spot where pain occurs is near the lower end of the
humerus, the bone that connects your shoulder to your forearm at the elbow.
By contrast, both the pain of golfer's
elbow and the pain of little leaguer's elbow occur at the bony prominence on the
inside of your elbow (medial epicondyle). These conditions also go by the name medial
epicondylitis.
Although playing tennis is one cause of
tennis elbow, many other common activities can cause the condition. Treatments
commonly involve rest and use of anti-inflammatory medications. Rarely, surgery
is an option.
Signs and symptoms
Signs and symptoms of tennis elbow may
include:
 | Pain that radiates
from the outside of your elbow into your forearm and wrist
| Pain when you touch
or bump the outside of your elbow
| A weak grip
| A painful grip
during certain activities, such as shaking hands or twisting a doorknob
| Pain when you extend
your wrist |
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You also may feel pain even when you aren't
moving your arm.
Causes
Tennis elbow is an overuse injury,
involving repeated contraction of the forearm muscles that straighten and raise
your hand and wrist. The repeated motions and stress to the tissue may result in
inflammation or a series of tiny tears of the tendons that attach the forearm
muscles to the bone at the outside of your elbow.
As the name tennis elbow
indicates, playing tennis — particularly, repeated use of the backhand stroke
with poor technique — is one possible cause of the condition. However, quite a
wide range of common arm motions can result in tennis elbow. These activities
may include using a screwdriver, hammering, painting and others.
When to seek medical advice
If self-care steps such as rest, ice and
use of over-the-counter pain relievers don't result in improvement of your
symptoms within a week or so, see your doctor to rule out other complications.
Seek medical care immediately if:
| Your elbow is hot
and inflamed, and you have a fever.
| You can't bend your
elbow at all, or it looks deformed.
| You've had a fall or
injury that makes you wonder if a bone is broken. |
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Screening and diagnosis
Your doctor may be able to diagnose tennis
elbow by examining your elbow and asking you questions about your symptoms. An
X-ray can help your doctor rule out other possible causes of elbow pain, such as
a fracture or arthritis.
Complications
Left untreated, tennis elbow can result in
chronic pain. You may find the pain restricts your motion, and you may have pain
when lifting or gripping objects or when opening doors. Avoiding using your arm
in certain ways can lead to loss of some of the function of your arm. In
addition, overusing the arm again before it has healed can result in a worse
injury.
Treatment
Initial treatment of tennis elbow usually
involves self-care steps including rest, icing the area and use of acetaminophen
(Tylenol, others) or over-the-counter (OTC) anti-inflammatory medications, such
as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others). If those steps
don't help and you still have pain and limited motion after a week or so, your
doctor may suggest other steps. These may include:
| Analyzing
the way you use your arm at work or at play. Your doctor may
suggest that experts evaluate your tennis technique or job tasks to
determine the best steps to reduce stress on your injured tissue. This may
mean going to a two-handed backhand in tennis or taking ergonomic steps at
work to ensure that the way you use your wrist and forearm doesn't continue
to contribute to your symptoms.
| Exercises.
Your doctor — or physical therapist to whom you've been referred by your
doctor — may suggest exercises to gradually stretch and strengthen your
muscles, especially the muscles of your forearm. Once you've learned these
exercises, you can do them at home or at work. Your doctor may also suggest
you wear straps or braces to reduce stress on the injured tissue.
| Corticosteroids.
If your pain is severe and persistent, your doctor may suggest an injection
of a corticosteroid medication. Corticosteroids are drugs that help to
reduce pain, swelling and inflammation. Injectable corticosteroids rarely
cause serious side effects, although they may temporarily raise blood sugar
levels in people with diabetes. However, these medications don't provide a
clear long-term benefit over physical therapy exercises or taking a wait and
see approach and simply resting your arm. Your doctor may also suggest use
of topical corticosteroids for pain relief. These corticosteroids are
absorbed through your skin during a treatment called iontophoresis, which
involves drawing the medication into the tissue through electrical charges.
| Surgery.
If other approaches haven't relieved your pain, if you've been faithful with
your rehabilitation program and given it enough time, and if the activity of
your arm is still restricted, your doctor may suggest surgery. Only about
one in 10 people with tennis elbow need surgery. You'll be able to have the
surgery done on an outpatient basis, meaning you can go home the same day.
Surgery involves either trimming the inflamed tendon, or surgically
releasing and then reattaching the tendon to relieve pain. |
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Other treatments for tennis elbow are being
investigated. Some treatments being studied include low-energy shock wave
treatment and treatment with topical nitric oxide.
Prevention
These steps may help you prevent a tennis
elbow injury:
| Review your
technique. Have a tennis professional review your technique to see
if you're using the proper motion. Swing the racket with your whole arm and
get your entire body involved in the stroke, not just your wrist. Keep your
wrist rigid during ball contact. Also, make sure you have the proper racket
grip size and string tension. Lower string tension of around 55 pounds
transmits less force up to the elbow.
| Build your
strength. Prepare for any sport season with appropriate preseason
conditioning. Do strengthening exercises with a hand weight by flexing and
extending your wrists. Letting the weight down slowly after extending your
wrist is one way of building strength so that force is absorbed into your
tissue.
| Keep your
wrist straight. During any lifting activity — including weight
training — or during tennis strokes, try to keep your wrist straight and
rigid. Let the bigger, more powerful muscles of your upper arm do more of
the work than your smaller forearm muscles do.
| Warm up
properly. Gently stretch the forearm muscles at your wrist before
and after use.
| Use ice.
After heavy use of your arm, try applying an ice pack or use ice massage. |
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Self-care
Follow the instructions for P.R.I.C.E.
(protect, rest, ice, compress, elevate):
| Protect
your elbow from further injury by not using the joint. If a particular sport
or work activity causes symptoms, you may have to stop the activity until
your symptoms improve.
| Rest
your elbow. But don't avoid all activity. Sometimes, wearing a forearm
splint at night helps reduce morning symptoms.
| Ice
the area. Using a cold pack, ice massage, a slush bath or a compression
sleeve filled with cold water is the best way to limit swelling after an
injury. Try to apply ice as soon as possible after the injury.
| Compress
the area using an elastic wrap or bandage.
| Elevate
your elbow above heart level when possible to help prevent or limit
swelling. |
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Taking these other self-care steps may
help:
| Massage the
area. Massage — especially a technique called cross-fiber or
friction massage, which you can learn from your physical therapist — may
speed healing by improving circulation in the area.
| Take
acetaminophen or anti-inflammatory medications. Using
over-the-counter (OTC) acetaminophen (Tylenol, others) or an OTC
anti-inflammatory medication such as ibuprofen (Advil, Motrin, others) or
naproxen (Aleve, others) may relieve pain. |
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