Tennis elbow

Overview

Tennis elbow, also known as lateral epicondylitis, is a condition that can result from overuse of the muscles and tendons in the elbow. Tennis elbow is often linked to repeated motions of the wrist and arm.

Despite its name, most people who get tennis elbow don't play tennis. Some people have jobs that involve repeated movements that can lead to tennis elbow. These include plumbers, painters, carpenters and butchers. However, often tennis elbow has no clear cause.

The pain of tennis elbow occurs mainly where the tough, cord-like tissues of the forearm muscles attach to a bony bump on the outside of the elbow. The tissues are known as tendons. Pain can spread into the forearm and wrist.

Rest, pain medicines and physical therapy often help relieve tennis elbow. People for whom these treatments don't help or who have symptoms that get in the way of daily living might have a procedure, such as a shot or surgery.

Symptoms

The pain of tennis elbow can travel from the outside of the elbow into the forearm and wrist. Pain and weakness can make it hard to:

• Shake hands or grip an object.
• Turn a doorknob.
• Hold a coffee cup.

When to see a doctor

Talk to a health care provider if self-care steps such as rest, ice and pain relievers don't ease your elbow pain and tenderness.

Causes

Tennis elbow is often linked to overuse and muscle strain. But the cause is not well understood. Sometimes, repeated tensing of the forearm muscles that are used to straighten and raise the hand and wrist triggers the symptoms. This can cause a breakdown of the fibers in the tendon that attaches the forearm muscles to the bony bump at the outside of the elbow.

Activities that can cause tennis elbow symptoms include:

• Playing racket sports, especially using backhand, with poor form.
• Using plumbing tools.
• Painting.
• Driving screws.
• Cutting up foods for cooking, particularly meat.
• Using a computer mouse a lot.

Less often, an injury or a condition that affects the body's connective tissues causes tennis elbow. Often, the cause isn't known.

Risk factors

Factors that can increase the risk of tennis elbow include:

• Age. Tennis elbow affects people of all ages. But it's most common in adults between the ages of 30 and 60.
• Work. People who have jobs that involve repeating motions of the wrist and arm are more likely to develop tennis elbow. These include plumbers, painters, carpenters, butchers and cooks.
• Certain sports. Playing racket sports increases the risk of tennis elbow. Not having good form or using poor equipment increases the risk even more. Playing more than two hours a day also increases the risk.

Other factors that can increase the risk include smoking, being obese and certain medicines.

Diagnosis

Often, medical history and an exam are enough to diagnose tennis elbow. During the physical exam, a health care provider might press on the affected area or ask you to move your elbow, wrist and fingers in various ways.

X-rays, sonograms or other types of imaging tests might be needed if a care provider suspects something else might be causing the symptoms.

Treatment

Tennis elbow often gets better on its own. But if pain medicines and other self-care measures aren't helping, physical therapy might be the next step. A procedure, such as a shot or surgery, might help tennis elbow that doesn't heal with other treatments.

Therapy

If symptoms are related to tennis or job tasks, an expert might look at how you play tennis or do job tasks or check your equipment. This is to find the best ways to reduce stress on injured tissue.

A physical, occupational or hand therapist can teach exercises to strengthen the muscles and tendons in the forearm. A forearm strap or brace might reduce stress on the injured tissue.

Surgical or other procedures

• Shots. Different types of shots into the affected tendon are used to treat tennis elbow. They include corticosteroids and platelet-rich plasma. Less commonly used are botulinum toxin A (Botox) or an irritant solution, either sugar water or salt water, known as prolotherapy.

  Dry needling, in which a needle gently pierces the damaged tendon in many places, also can be helpful.

• Needle fenestration. This procedure uses ultrasound to guide a needle through a numbed tendon again and again. This starts a new healing process in the tendon.
• Ultrasonic tenotomy, called a TENEX procedure. Similar to needle fenestration, this procedure uses ultrasound to guide a special needle through the skin and into the damaged part of the tendon. Ultrasonic energy vibrates the needle so fast that the damaged tissue turns to liquid. It then can be sucked out.
• Extracorporeal shock wave therapy. This treatment involves sending shock waves to injured tissue to relieve pain and help the tissue heal. A tool placed on the skin delivers the shock waves.

• Surgery. For symptoms that haven't improved after 6 to 12 months of other treatments, surgery to remove damaged tissue might be an option. The surgery might be open, which uses a large cut, known as an incision. Or it can be done through several small openings, known as arthroscopic.

  Whatever the treatment, exercises to rebuild strength and regain use of the elbow are vital to recovery.

Lifestyle and home remedies

The following self-care measures might relieve tennis elbow:

• Rest. Do not do activities that aggravate elbow pain.
• Pain relievers. Try pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
• Ice. Apply ice or a cold pack for 15 minutes 3 to 4 times a day.

Preparing for an appointment

You'll likely start by seeing your health care provider. You might then go to a sports medicine specialist or an orthopedic surgeon.

What you can do

Before your appointment, you may want to have answers to these questions:

• When did your symptoms begin?
• Does any motion or activity make the pain better or worse?
• Have you recently injured your elbow?
• What medications or supplements do you take?

What to expect from your doctor

Your health care provider may ask some of the following questions:

• Do you have rheumatoid arthritis or a nerve disease?
• Does your job involve repetitive motions of your wrist or arm?
• Do you play sports? If so, what types of sports do you play? Has your form ever been evaluated?