TENNIS ELBOW (LATERAL EPICONDYLITIS): SYMPTOMS, CAUSES, AND TREATMENT

Tennis elbow, aka lateral epicondylitis, is the tearing and inflammation of the tendons that attach your forearm muscles to the bony bulging part on the outside of your elbow. It is the most common reason for elbow pain and typically occurs in men and women in their 40’s.

Tennis elbow happens when you overwork your tendons through intense and repetitive movements of your arm, wrist, and fingers. Contrary to what the name implies, tennis elbow is not exclusively related to tennis. It can be related to several other professions as well, such as plumbers, artists, and carpenters.

Lateral epicondylitis generally causes pain on the outer side of your elbow, and the pain might sometimes extend down along your forearm and wrist.     

To control your symptoms, you might benefit from resting, bracing your elbow, and pain medications. If conservative measures fail to relieve your pain, your doctor might recommend surgical intervention. 

What is tennis elbow and what are its causes?

Tennis elbow is a debilitating overuse injury that usually results from the continuous straining of the tendons responsible for the extension (i.e. backward movement) of your wrist and fingers.

It is primarily caused by tasks that require heavy repeated gripping and wrist extension, like tightly holding a racquet during a swing or lifting weights. These extensive recurrent movements lead to the development of tiny tears at the site of attachment of your tendons to the outer aspect of your elbow. This results in tendon damage and inflammation and subsequent arm and hand pain and weakness.

Tennis elbow was originally thought to be exclusive to sports as tennis and racquetball when athletes use the wrong techniques and equipment. It was later found to be common in any activity that exerts similar stress on your tendons (e.g. knitting, typing, painting…).

What are the symptoms of tennis elbow?

People who have tennis elbow most commonly complain of:

• Pain
• Burning
• Weakened grip

Symptoms are mostly felt at the outer part of your elbow but may travel lower down along your forearm and wrist. You might feel the pain when you touch your outer elbow.

You’ll likely experience gradual development of your symptoms, starting mild and slowly increasing over weeks to months. Sometimes, pain is felt at night. 

No particular event or injury leads to the onset of your tennis elbow symptoms. They usually start in your dominant arm, but both your arms can be affected.

Even though the damage is near your elbow, it might be painful and difficult to do tasks with your hands. A flare-up of your symptoms might impair simple daily activities:

• Turning a door handle
• Holding a cup
• Gripping a pencil
• Lifting something
• Clenching a fist
• Bending your arm

What are the risk factors of tennis elbow?

Occasionally, you might develop lateral epicondylitis without having a clearly identified cause.

Risk factors that might be associated with tennis elbow: 

• Age: Patients usually develop tennis elbow in their 40’s. It might occur earlier if you have other significant risk factors.
• Work-related activities: Jobs that require repetitive wrist and arm movements are associated with tennis elbow (carpentry, plumbing, cooking, knitting, typing, painting …).
• Sports: Athletes are at high risk for developing tennis elbow syndrome. Racket sport (tennis, squash, and badminton) and weight lifting are well-known risks.

How is tennis elbow diagnosed?

Tennis elbow is a clinical diagnosis. Your doctor will ask about your symptoms and the tasks that worsen them, your occupation, sports (whether you’re involved in racket sports or lifting weights), and illnesses. He/she will also ask about the location and characteristics of your pain.

After that, your doctor will examine you by applying slight pressure on the outer aspect of your elbow to check for pain.

This is usually enough to confirm tennis elbow syndrome. However, if your doctor is still not sure, they might recommend further testing:

• X-ray: to rule out arthritis of the elbow (i.e. inflammation of the joint).  
• MRI scan: to check for tendon damage.
• Electromyography: to rule out nerve compression, because this might have a presentation similar to tennis elbow.

How is Tennis Elbow syndrome treated?

Your tennis elbow usually improves without any treatment. However, if your tennis elbow fails to heal on its own, your doctor might recommend further interventions depending on the severity of your condition:

Conservative Management

80-95% of tennis elbow cases are managed conservatively, without the need for surgery:

• Resting: Avoid involvement in heavy sports and work-related activities.
• Cold compressors: Wrap a bag of ice with a towel and apply it to the site of pain.
• Equipment and technique check: Seek professional advice concerning your equipment and technique if you’re involved in sports like tennis or weight lifting.
• Medications: Use pain killers and anti-inflammatory agents to control your pain after consulting with your doctor.
• Physiotherapy: A specialist physiotherapist will help you perform exercises that strengthen your forearm muscles (e.g. stretch your wrist while extending your elbow).
• Brace: You might be asked to wear a brace on the back of your forearm to rest your muscles and tendons and relieve pain.
• Steroid injections: Steroids are known to have an effective anti-inflammatory effect. Your doctor might use them to treat tennis elbow.
• Platelet-rich plasma (PRP): The efficacy of PRP injections is still under investigation, however, it has shown a lot of promise in treating musculoskeletal disorders. 
• Surgery: Surgical intervention is reserved for those with severe pain or pain not responding to 6-12 months of conservative measures. Your doctor will remove the damaged part of your tendon. Most full recoveries are reached after 1 year. 

What are the potential risks of surgery?

The risks of tennis elbow surgery include: 

• Loss of strength and flexibility
• Damage to nearby structures (nerves and blood vessels)
• Infection
• The need for prolonged rehabilitation or additional surgery.

What to expect after your tennis elbow surgery?

• You must immobilize your arm with a splint for 1 week, after which the splint and sutures are removed.
• Then, you will be instructed to start exercises that stretch your elbow and restore its flexibility, possibly with the aid of a professional physiotherapist.
• 2 months after your surgery, you can gradually and gently start some strengthening exercises.
• Your doctor will advise you about when to return to your work and sports. This might need up to 6 months after surgery if your tasks are usually manual. 

FAQs about tennis elbow

1. Can tennis elbow heal without treatment?

In most cases, tennis elbow heals on its own. To speed up your recovery, you can refer to other measures (medications, cold compressors, bracing, etc.)

2. Is massage effective for tennis elbow symptoms?

Massage is a part of the physical therapy recommended for tennis elbow. It helps speed up the healing of your muscles and relieves your pain

3. What part of the elbow hurts with tennis elbow?

Pain is mostly felt at your outer elbow. The pain, however, might extend to your forearm and wrist.

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Sources

• Dutton M: Dutton's Orthopaedic Examination, Evaluation, and Intervention, 3^rd Edition: www.accessphysiotherapy.com
• https://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis/
• https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987
• https://www.webmd.com/fitness-exercise/tennis-elbow-lateral-epicondylitis#1
• https://www.webmd.com/pain-management/tennis-elbow
• https://www.nhs.uk/conditions/tennis-elbow/
• https://www.healthline.com/health/fitness-exercise/tennis-elbow-rehab#_noHeaderPrefixedContent
• https://www.medicalnewstoday.com/articles/175848#symptoms
• https://www.knoxorthopedic.com/f-s-t-cure-tennis-elbow-lateral-epicondylitis/
• https://www.ncbi.nlm.nih.gov/books/NBK431092/

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