What is tennis elbow?

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Surprisingly, most people develop tennis elbow without playing tennis. Tennis elbow involves the wearing down of the tendons in your elbow secondary to overuse.

Your elbow joint is a joint made up of three bones: your upper arm bone called the humerus and two bones in your forearm called the radius and ulna. The bony bumps at the sides of the elbow are called epicondyles. The bony bump on the outside of the elbow is called the lateral epicondyle.

Your top forearm muscles attach to the lateral epicondyle. This is the area that can become inflamed and painful with tennis elbow.

What is the cause of tennis elbow?

Studies have shown that tennis elbow is often due to damage to specific forearm muscles, most frequently the extensor carpi radialis brevis (ECRB). When this muscle is weakened from overuse, you get microscopic tears in the tendon where it attaches to the lateral epicondyle. This is what leads to the significant pain and dysfunction. You may notice that you have this pain when you try to grip or grasp anything with your hand. This is because the muscles that attach to the lateral epicondyle also control your hand and fingers.

Who gets tennis elbow?

Tennis elbow affects tennis players, but also affects many other people. Anyone who’s job or activities require repetitive use of the wrist and hand are prone to this condition. Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have also shown that autoworkers, cooks, and even butchers get tennis elbow more often than the rest of the population.

Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the right risk factors. Tennis elbow is so common that I have heard it described as a rite of passage to middle age.

What are the symptoms of tennis elbow?

Most commonly, the symptoms of tennis elbow developed gradually. In most cases, the pain begins as mild and slowly worsens over weeks to months. There is usually no specific injury associated with the start of symptoms. The common signs and symptoms of tennis elbow are:

· pain or burning on the outer part of the elbow

· weak grip strength

· significant pain with gripping or grasping with your hand

How is tennis elbow diagnosed?

Tennis elbow is normally diagnosed by medical history and physical examination. I first begin by asking about your symptoms, any risk factors, and recreational sports participation. We will also talk about what activities cause your symptoms. During the examination, I use a variety of tests to confirm my diagnosis. Infrequently, I may recommend imaging such as x-ray, MRI, or ultrasound to confirm the diagnosis, however, this is not commonly necessary.

What is the treatment of tennis elbow?

Approximately 80 to 95% of patients have success with nonoperative treatment of tennis elbow. This can, however, take several months to resolve. Studies have shown that symptoms can last to up to and beyond 12 months. The mainstay of treatment is rest and avoidance of activities that cause pain. In the past, many physicians have recommended steroid injections to treat this condition. Elbow specialists, like myself, no longer recommend this treatment. This recommendation is based on several studies that have shown that steroid injections only cause temporary relief and have worse long-term outcomes.

Some patients do not improve with nonoperative treatment, however. If this is the case, I normally recommend minimally invasive arthroscopic surgery to clean up the torn tendon in the elbow. This outpatient surgery involves small poke holes around the elbow and takes approximately 30 to 60 minutes to complete. Some studies have shown relief of symptoms within two weeks, however, results can vary based on the patient.

Andrew Pastor M.D.