Tennis Elbow

Despite the name, many people who get tennis elbow are not tennis players. The condition is associated with repetitive movements of the wrist and arm.

Tennis elbow doesn't look the same for everyone. There are a wide range of pain responses from those who experience discomfort only when lifting heavy objects like weights at the gym to those with intense exacerbations of symptoms from simply lifting a cup of coffee.

What is Tennis Elbow?

Tennis elbow or lateral epicondylitis is an overuse injury caused by repeated extension of the wrist against resistance. Examples of this motion include repetitive gripping or lifting that puts too much strain on the tendons near the elbow. This condition occurs in those who consistently lift tools and heavy equipment such as carpenters and laborers, or play sports like baseball, swimming, and tennis with improper form and technique. Mechanically, it is caused by any activity involving repetitive wrist extension, radial deviation, and forearm supination.

Tennis elbow presents with pain and tenderness at the outside or lateral aspect of the elbow, usually 1 to 2 cm from the lateral epicondyle itself. The surrounding muscle may be significantly tight and tender to touch. There's a wide range of severity spanning from slight discomfort to severe. Pain is usually reproduced when the wrist and middle finger are extended.

Tennis elbow is a type of tendonitis which means inflammation of the tendon. Tendons are the portion of a muscle that connects it to a bone. Tendons are strong and are designed to take on a lot of force in our daily activities; however, they have limited blood supply which can make inflammation of these structures more difficult to recover from. Most tendonitis issues are addressed with a combination of rest and eccentric exercises in addition to stabilizing the entire limb so that the tendon does not have to take on as much work as it recovers.

How is Tennis Elbow Diagnosed?

A physical exam can help determine a clinical diagnosis. An examination of the arm will include looking at the structure and integrity of the joints, nerves, muscles, and skin. Tennis elbow is indicated by symptoms of pain over the lateral epicondyle where the extensor muscles (most commonly the extensor carpi radialis brevis). Movement tests to resist motion in specific muscles are performed to reproduce symptoms in order to confirm the diagnosis and involved structures. Grip strength is also considered in the testing for tennis elbow.

Imaging may be utilized by doctors if physical tests do not result in a clear diagnosis or if other structures are potentially involved. Imaging might include ultrasound to examine the integrity of the tendon and bursa, an Xray to check for bony abnormalities such as arthritis, and an EMG to assess nerve activity. MRIs may also be indicated in some circumstances.

Management of Tennis Elbow

• Ice and NSAIDs as well as rest from the exacerbating activity can help to decrease pain and inflammation of the tendons near the elbow.

  
  

• Physical therapy lead exercises can be helpful after the inflammation has subsided. Stretching and strengthening of the arm and wrist, and eccentric exercise will be performed to help the individual get back to their previous level of activity, emphasizing patient education to decrease the chance of recurrence. Manual therapy is beneficial for increasing range of motion through mobilization of the joint and soft tissue or deep friction massage of the affected muscles.

  
  

• Kinesio taping can be very beneficial in reducing pain and improving functionality.

  
  

• Forearm counterforce straps are sometimes used during activity to take stress off of the extensors.

  
  

• Steroid injections can be used in severe cases to decrease pain so that the patient can be more functional in their day to day life and so they can better participate in physical therapy.

What can we do to help prevent tennis elbow?

• Warming up before activity and stretching afterwards

  
  

• Remembering proper posture in everyday life and performing activities with good form

  
  

• Utilizing stabilizing muscles of the full shoulder girdle and avoiding unnecessary wrist extension with lifting

  
  

• Giving the body time to rest and recover after intense activity

  
  

• Not "playing through the pain" and instead giving your body time to recover

Fun facts

• Tennis elbow has been known to take up to 2 years to resolve in those who do nothing to rehabilitate themselves

  
  

• Only 5% of tennis elbow sufferers actually have tennis to blame

  
  

• Up to 50% of all tennis players develop symptoms of tennis elbow due to frequency or bad form

  
  

• Recurrence rates have been shown to be as high as 54% if proper precautions are not taken

  
  

• Lateral epicondylitis or tennis elbow is seven times more common than medial epicondylitis or golfer's elbow

  
  

• Tennis elbow tends to affect men and women equally