What is tennis elbow?
Tennis elbow is an inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow. There may be a partial tear of the tendon fibers, which connect muscle to bone, at or near their point of origin on the outside of the elbow. In tennis elbow, the tendons on the outside of the elbow (the lateral epicondyle) are affected. In golfer's elbow (medial
epicondylitis), another form of tendonitis, the tendons on the inside of the elbow are affected. The inflamed tendons may be strained or have tiny tears caused by overusing the muscles that control the wrist and fingers.
Tennis elbow is usually caused by repeated twisting hand, wrist, or forearm movements done during everyday activity, such as using a screwdriver or scissors, gardening, and various sports. It can also be caused by a direct blow to the lateral elbow. Tennis elbow generally occurs in adults between the ages of 40 and 60 and is most common during the 40s. People at risk for tennis elbow are those in occupations that require strenuous or repetitive forearm movement. Such jobs include mechanics or carpentry. Sport activities that require individuals to twist the hand, wrist, and forearm, such as tennis, throwing a ball, bowling, golfing, and skiing, can cause tennis elbow. Individuals in poor physical condition, who are exposed to repetitive wrist and forearm movements for long periods of time, may be prone to tennis elbow. This condition is also called epicondylitis, lateral epicondylitis, medial epicondylitis, or golfer's elbow, where pain is present at the inside epicondyle.
Tennis elbow causes pain, tenderness and sometimes swelling of the elbow and forearm on the affected side. Individuals experiencing tennis elbow may complain of pain and tenderness over either of the two epicondyles. The main symptom of tennis elbow is pain on the outside of the elbow when the person uses the muscles that straighten the wrist and fingers. Some people complain of pain throughout the lower arm. Pain can also occur when lifting anything, even a lightweight cup, with the palm facing down. The outside of the elbow is usually tender to the touch. Grabbing or twisting movements of the arm are commonly painful. When the wrist or fingers are straightened against resistance or a tight fist is made, pain may occur. There may be some swelling over the outside of the elbow, but this is unusual. The elbow should have its full range of motion.
Treatment is aimed at pain relief and reducing inflammation. Heat or ice is helpful in relieving tennis elbow pain. Once acute symptoms have subsided, heat treatments are used to increase blood circulation and promote healing. The physician may recommend physical therapy to apply diathermy or ultrasound to the inflamed site. These are two common modalities used to increase the thermal temperature of the tissues in order to address both pain and inflammation. Occasionally, a tennis elbow splint may be useful to help decrease stress on the elbow throughout daily activities. Exercises become very important to improve flexibility to all forearm muscles, and will aid in decreasing muscle and tendon tightness that has been creating excessive pull at the common attachment of the epicondyle. The physician may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) to reduce inflammation and pain. Injections of cortisone or anesthetics are often used if physical therapy is ineffective. Cortisone reduces inflammation, and anesthetics temporarily relieve pain. Physicians are cautious regarding excessive number of injections as this has recently been found to weaken the tendon's integrity. To prevent the recurrence of the injury, a splint may be worn during aggravating activities, or the activities may need to be modified. If the pain persists despite these nonoperative treatments, surgery may be necessary.