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Tennis elbow (lateral epicondylitis)

What is Tennis Elbow?

Tennis elbow, or lateral epicondylitis, is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. Racket sports like tennis and pickleball tend to be a major cause for this injury and elbow pain, but any heavy use of the elbow with repetitive gripping and lifting can be a cause of this condition. It is a common work-related injury for plumbers, painters, carpenters, mechanics, and butchers. Generally, lateral epicondylitis develops gradually, but at times can occur acutely from an injury.

Tennis Elbow Causes

  • Extended use in activity: Engaging in repetitive activities that involve the forearm muscles, such as gripping, twisting, or lifting, for an extended period can contribute to tennis elbow. These activities can strain the tendons in the elbow, leading to inflammation and pain.
  • Wear and tear of overuse: Overuse of the forearm muscles without adequate rest and recovery can lead to wear and tear of the tendons, causing tennis elbow. This can occur in various occupations or recreational activities that involve repetitive motions, such as painting, plumbing, or playing musical instruments.
  • Improper equipment in sports like tennis: In sports like tennis, using improper equipment or techniques can increase the risk of developing tennis elbow. For example, using a racquet with an ill-fitted grip size or playing with a technique that places excessive strain on the forearm muscles can contribute to the condition.

Tennis Elbow Risk Factors

  • History of rheumatoid arthritis: Rheumatoid arthritis is an autoimmune condition that causes inflammation and damage to joints, including the elbow. Individuals with a history of rheumatoid arthritis may be at an increased risk of developing tennis elbow.
  • History of nerve disease: Certain nerve diseases or conditions can affect the function and health of the nerves in the forearm and elbow. These conditions may increase the likelihood of developing tennis elbow.
  • Dominant arm primarily affected: Tennis elbow commonly affects the dominant arm, which is the arm predominantly used for activities and sports. The repetitive motions and overuse of the forearm muscles in the dominant arm can contribute to the development of tennis elbow.

Tennis Elbow Symptoms

  • Tenderness in the outer elbow: One of the main symptoms of tennis elbow is tenderness or pain located on the outside of the elbow. This tenderness is often localized to the bony prominence called the lateral epicondyle.
  • Burning sensation in the elbow: Some individuals with tennis elbow may experience a burning sensation in the affected elbow. This sensation can be present at rest or during activities involving the forearm muscles.
  • Pain and weakness when using the affected elbow: Tennis elbow can cause pain and weakness in the elbow, particularly when performing activities that involve gripping, lifting, or twisting motions. Everyday tasks like shaking hands, turning a doorknob, or gripping a tool can become painful and challenging.
  • Pain with resistance: When pressure or resistance is applied to the wrist or forearm muscles, individuals with tennis elbow may experience increased pain. This can be observed when attempting to lift or carry objects or when performing activities that require forearm muscle contraction against resistance.
  • Pain and weakness with gripping/lifting: Tennis elbow can make gripping and lifting objects difficult and painful. Even simple tasks like holding a coffee cup, lifting a book, or carrying groceries may elicit discomfort and weakness.

Tennis Elbow Diagnosis and treatment

Several factors are considered by the doctors when making the diagnosis, including history of related injury, use, and health. Tests such as x-ray may be utilized to rule out other possible causes for elbow pain, such as arthritis or a fracture. The majority of tennis elbow treatment is done without surgery.

Nonsurgical treatment options include:

  • Short period of rest
  • Keep your elbow moving to prevent stiffness
  • Avoid aggravating activities such as lifting/forceful gripping
  • Short term nonsteroidal anti-inflammatories (NSAID’s)
  • Massage to painful area to increase blood flow and desensitize
  • Stretching exercises to maintain flexibility of the elbow and wrist
  • Topical anti-inflammatory/pain relief creams
  • Compressive elbow wrap
  • Wrist brace
  • Acupuncture
  • Physical therapy

The vast majority of cases will resolve with this type of treatment, but symptoms may last for 6 – 12 months or longer.