What is tennis elbow?
Tennis elbow (lateral epicondylitis) is a condition in which there is pain where the tendons from the forearm extensor muscles attach to the bony prominence on the outside of the elbow (lateral epicondyle). It is a degenerative condition of the common extensor tendon associated with overuse, not specifically with playing tennis. Another condition - golfer's elbow - results in pain on the inside of the elbow.
What are the symptoms?
There is pain over the outside of the elbow, which may radiate into the forearm and wrist. The pain usually comes on gradually, and is made worse by repetitive extension of the wrist (moving the back of your hand towards the back of your forearm) or rotation of the forearm.
In severe cases, there may be local swelling and some activities, such as making a fist, shaking hands, carrying bags like a briefcase or groceries, lifting saucepans or turning on taps may be painful.
What causes tennis elbow?
Lateral epicondylitis (also known as common extensor origin tendinosis) is due to degeneration of the tendon fibres resulting from overuse of the muscles responsible for bending back (extending) the wrist and lifting the hand.
It commonly occurs in people between the ages of 35 and 55, but does occur in other age groups too.
Although it is commonly called ‘tennis elbow’, the condition is not just caused by playing tennis. It can be caused by many other activities involving repetitive use of these muscles, such as gardening, painting, using a screwdriver or other racquet sports. Using a computer keyboard or mouse incorrectly, particularly with poor posture, can also contribute.
Usually, doctors are able to make the diagnosis based on the history and a physical examination. X-rays may be used to help rule out other causes of elbow pain, such as arthritis. An ultrasound or magnetic resonance imaging (MRI) scan will show the degenerative changes in the tendon, but is rarely required.
What is the treatment for tennis elbow?
Tennis elbow is often chronic, lasting for several months. It sometimes gets better on its own within 6 months to 2 years.
Initial treatment involves the application of ice, taking analgesics (pain relievers) and relative rest (avoiding activities that aggravate the pain). Wearing a tennis elbow brace can help to protect the tendon.
Physiotherapy is useful, and the physiotherapist can show you exercises to stretch and strengthen the muscles of the forearm. Specifically, progressively loading the extensor muscles with a program of strengthening exercises is important.
For more severe or persistent pain, corticosteroid injections may be an option, but will offer short-term relief only. Repetitive injections of corticosteroid are dangerous as they can cause the tendon to weaken and possibly even rupture.
Platelet-rich plasma injections have recently showed promise in accelerating the healing of this condition.
Surgery is rarely required, but may be considered if 6 to 12 months of non-surgical treatment has not been effective. It is important to ensure the diagnosis is accurate and the pain is not arising from the neck, thoracic spine or from a rib ring dysfunction.