Tennis elbow

What is tennis elbow?

Tennis elbow (lateral epicondylitis) is the most common cause of elbow pain in adults. Pain occurs on the outside of the elbow at the bony prominence known as the epicondyle, where the muscle-tendons of the forearm and wrist attach. Movements associated with tennis–repetitive stresses with forearm supination (turning the forearm over with the palm up) and wrist extension–gave this condition its nickname, although many patients with tennis elbow do not actually play tennis.

Furthermore, the word “tendonitis” refers to inflammation (“itis”) of the tendon, when in fact there is no real inflammatory component. The true pathology is what is referred to as “tendinosis,” referring to degenerative changes in the tendon at the attachment site.

WOSM’s Elbow Experts

What causes tennis elbow?

  • Chronic repetitive stress and strain to muscles and tendons of the forearm and wrist
  • Sudden increase in activity level or intensity
  • In tennis and other racquet sports, an inappropriately sized grip, racquet or string tension
  • Incorrect hitting position or technique (usually backhand; leading with the elbow)

What increases my risk?

  • Sports or jobs requiring repetitive and strenuous forearm and wrist movements (tennis, squash, racquetball, carpentry)
  • Sports that require strenuous or repetitive forearm movement (tennis, racquetball, “lead arm” in golf)
  • Poor physical conditioning (strength and flexibility)
  • Inadequate warm-up before activity
  • Resumption of activity before healing and rehabilitation and conditioning are complete

What are the symptoms of tennis elbow?

  • Pain and tenderness on the outside of the elbow
  • Pain or weakness with gripping activities
  • Pain upon twisting the wrist (playing tennis, using a screwdriver, opening a door or a jar)
  • Pain upon lifting objects

How is tennis elbow diagnosed?

  • Reported history of pain on the outside of the elbow , with focal tenderness over the bony prominence (epicondyle)
  • Pain with wrist extension against resistance
  • Pain with forearm supination against resistance

Are special tests required to diagnose tennis elbow?

  • X-rays are usually normal
  • MRI is unnecessary except in cases that are atypical ( e.g., history of prior surgery, significant trauma, swelling, difficulty with elbow motion)

How is tennis elbow treated?

Non-operative treatment is effective for many patients. Initial treatment consists of activity modification, ice, and anti-inflammatory medications.

Your physician may recommend using a “counterforce” brace (also called a tennis elbow strap) to splint the muscle-tendon unit just below where it attaches to the elbow. Gentle stretching and strengthening exercises are helpful as the symptoms subside. Persistent symptoms may justify physical therapy for further evaluation and treatment, and/or a cortisone injection.

Operative treatment

Surgery is indicated for patients whose symptoms do not respond to physical therapy and/or cortisone injections. It can be performed by either open or arthroscopic techniques. Both involve removal of the abnormal tissue responsible for causing pain. The success rate with surgical treatment is better than 90 percent.

When can you return to your sport or activity?

  • If symptoms are treated shortly after onset, improvement with conservative measures may allow for a quick return to activity. Chronic cases may require three to six months to resolve, and may require referral to a physical therapist or athletic trainer.
  • Chronic cases may require three to six months to resolve and may require referral to a physical therapist or athletic trainer

How can tennis elbow be prevented?

  • Appropriately warm up and stretching before practice or competition
  • Maintain wrist/forearm flexibility and muscle strength/endurance
  • Ensure proper equipment fit (i.e., racquet size/weight and grip)
  • Maintain proper technique