Everything You Need to Know About Tennis Elbow

Tennis elbow, also called lateral epicondylitis, is an overuse injury that causes pain and inflammation in the tendons of your forearm. Symptoms may include soreness on the outside of the elbow and weak grip strength. Anyone can get tennis elbow, but people who put repetitive stress on the elbow are at higher risk.

Treatment for lateral epicondylitis can include rest, medication, braces or splints, and tennis elbow exercises. In most cases, tennis elbow resolves on its own with proper care.

What Is Tennis Elbow?

Tennis elbow is a form of tendinitis. It involves swelling, inflammation, and subsequent tearing of the tendons in your forearm, usually the exterior carpi radialis brevis (ECRB). This tendon is the attachment site of the muscle that functions to bend the wrist back (called wrist extension).

The ECRB connects the forearm muscles to the upper arm bone (humerus) at the outside part of the elbow bone called the lateral epicondyle, thus giving tennis elbow the medical name "lateral epicondylitis."

With repetitive stress, this tendon can become overtaxed, causing it to pull away from the bone and creating microscopic tears. When this happens, you'll notice an aching or burning pain that gets worse when you grip or lift something.

Sometimes, tennis elbow can be confused with other conditions, such as bursitis or golfer's elbow. Thus, it's best to have the condition diagnosed by a healthcare provider. 

Symptoms

The most common symptoms of tennis elbow include:

• An aching or burning pain over the outside of the elbow that is worsened by gripping or lifting
• Pain starts at the elbow but then may spread to the forearm
• Weak grip strength

The pain associated with tennis elbow usually has a gradual onset, but it may also come on suddenly. Pain can be highly variable too, ranging from very mild to severe and debilitating.

Causes

The primary cause of tennis elbow is overuse of the elbow which leads to inflammation of the carpi radialis brevis tendon. However, as a result of repetitive movements, experts believe that microscopic tears develop within the tendon and these tears do not heal completely, causing more damage.

This leads to a degenerative ("wear and tear") process and subsequent pain and tenderness felt at the outside of the elbow.

Experts also believe that the position of the ECRB may play a role in causing tennis elbow. When you bend or straighten the elbow, the forearm muscle rubs against bony prominences at the lateral epicondyle, which can cause gradual wear and tear of the muscle over time.

Besides activities that require repetitive gripping and grasping, trauma (in the form of a direct hit to the elbow that leads to tendon swelling) can also cause tennis elbow, although this is a less common culprit.

Risk Factors

Despite its name, tennis elbow does not solely occur in tennis players. There are two groups of people that are especially vulnerable to developing this condition:

• Sports participants: Athletes, especially racquet sport players (including pickleball), are prone to developing tennis elbow. About a third of amateur tennis players experience tennis elbow at some point in their careers. In addition to racquet sports, tennis elbow is seen in golfers, fencers, and other sports participants.
• Manual laborers: People who work with their hands are at greater risk of developing tennis elbow. Jobs that may lead to tennis elbow include plumbers, painters, gardeners, and carpenters.

Diagnosis

The diagnosis of tennis elbow is made through a medical history and physical examination. Additional tests may be ordered to rule out other conditions that cause elbow pain.

Besides tennis elbow, there are several other causes of pain over the outside of the elbow including instability of the joint, elbow arthritis, radial tunnel syndrome, and cervical radiculopathy.

These conditions are generally considered if the symptoms are not typical for tennis elbow, or if a person with presumed tennis elbow does not respond to treatment.

Physical Examination

In addition to inquiring about the characteristics of your elbow pain (e.g., location and severity), your healthcare provider will ask you about any potential risk factors, like whether you have participated in a certain job or sports-related activities or experienced a recent elbow injury or trauma.

Your healthcare provider will also ask you about your medical history, like whether you have a history of rheumatoid arthritis or elbow nerve entrapment.

During the physical exam, your healthcare provider will press on your elbow at various sites to evaluate for tenderness. With tennis elbow, there is usually tenderness about one centimeter from the lateral epicondyle itself.

Your healthcare provider will also flex and extend your wrist while your arm and elbow are held out to see if this increases or reproduces your pain.

Other Tests

Various tests may be used to diagnose some of the above conditions.

These tests are commonly ordered to diagnosis tennis elbow or rule out other conditions.

• X-ray can provide images of the bones and may be helpful in ruling out elbow arthritis.
• MRI or magnetic resonance imaging (MRI) may show some abnormal changes with tennis elbow. An MRI can also be useful for diagnosing radial tunnel syndrome.
• Nerve conduction study and electromyography (EMG) are sometimes conducted to rule out nerve compression.
• Blood tests may be utilized to rule out or help diagnose inflammatory conditions like rheumatoid arthritis.
  

Treatment

Recovering from tennis elbow can be a long process. Some people achieve full recovery within one or two years after their symptoms begin. Others may recover completely in as little as six months.

The good news is that tennis elbow usually gets better on its own. Treatment of tennis elbow entails simple, non-surgical steps. With sufficient time, most individuals respond well.

Non-Surgical Therapies

For most people, one or more of the following treatments are effective for treating tennis elbow:

• Rest and activity modification: Stopping or significantly limiting activities that trigger and/or aggravate the condition (oftentimes for several weeks) is a key first step to healing.
• Equipment modifications: A stiffer racquet or a looser-strung racquet can help in reducing damage caused during activities.
• Ice packs: These reduce swelling and inflammation.
• Medication: Under the guidance of your healthcare provider, taking a nonsteroidal anti-inflammatory drug (NSAID), can ease inflammation and pain.
  
• Physical therapy: Performing exercises that stretch and strengthen your forearm muscles, as well as various techniques like ice massage, heat, or ultrasound, can help improve muscle function and speed up healing.
• Steroid injection: In certain cases, your healthcare provider may opt to inject cortisone (a strong anti-inflammatory medication) into the area near your lateral epicondyle.
• Platelet-rich plasma (PRP). Plasma obtained from other parts of the arm contains a high concentration of growth factors which can aid in healing.
• Extracorporeal shock wave therapy: Although experimental at this point, this treatment sends shock waves to the damaged tissue to aid in repair.

Braces and Splints

Wearing a tennis elbow brace (a band worn over the back of your forearm muscle just below your elbow) can ease the stress on the tendon and muscle.

A wrist brace can also be helpful. This type of brace restricts the use of your wrist, which will prevent excess strain on the tendons in your elbow.

Surgery

A small percentage of patients diagnosed with tennis elbow will ultimately require surgical treatment.

Generally speaking, patients may consider surgery if more conservative treatments are not effective after a period of six to 12 months.

Prevention

Keeping your arms flexible and strong is the first step to prevent tennis elbow from occurring or to prevent it from coming back.

Keep these prevention tips in mind:

• Avoid repetitive movements, if possible.
• Warm up adequately before doing any sports or other activities that involve repetitive movements.
• Get sports or work equipment checked regularly.

Certain exercises may also help to improve strength and flexibility in the arm. These include:

• Biceps curls to improve elbow flexion
• Squeezing a sock to increase grip strength
• Wrist extensor stretch or gently pressing against the back of your bent hand with the arm extended in front of you
• Wrist flexor stretch or gently pressing against the palm of your flexed hand with the arm extended in front of you
• Wrist curls to strengthen the forearm
• Wrist extensor strengthening or resting the arm up to the wrist on a table (letting the hand drop off the edge) and lifting and lowering a light weight
• Wrist rotation or holding a light weight in your hand and rotating at the wrist joint to improve mobility and strength

Summary

Tennis elbow or or lateral epicondylitis can happen to anyone who participates in repetitive arm movements, whether or not you play tennis. While it is a painful and frustrating condition, most of the time it resolves with non-surgical treatments like wearing a brace, using over the counter medications, and rest.

If you experience symptoms of tennis elbow, such as pain on the outside of the elbow, be sure to get it checked by a healthcare provider. Sometimes, the pain is the result of other conditions, like arthritis. A proper diagnosis will help you get the care you need to recover quickly.