Tennis elbow, also known as lateral epicondylitis, describes pain on the outside of the elbow. It is generally considered to be an overuse injury due to repetitive use of the muscles of the arm and forearm, particularly the muscles that extend the wrist and fingers (extensors). This leads to small tears in the tendons that attach to the outside of the elbow (lateral epicondyle) and can result in degeneration. This can then result in pain and inflammation.
Causes of Injury
Tennis elbow can occur as a result of any activity that involves repetitive use of the forearm muscles. As the name, suggests, it is also common in tennis players. There are a number of factors that can increase a person’s risk of developing tennis elbow, including:
- Activities involving prolonged gripping as with racquet sports, gardening or power tools, knitting or sewing, painting.
- Prolonged and repetitive use of hand tools, particularly hammering.
- Repetitive heavy lifting (bricklaying, weight lifting)
- Excessive computer or keyboard use.
- Recent increases in work or sport training intensity, frequency or duration or a change in equipment.
Signs and Symptoms
- Pain and tenderness on the outside of the elbow, which may spread down the arm to the fingers.
- Pain aggravated by activities such as gripping objects, twisting tops off jars or door knobs and carrying heavy objects.
- Pain initially relieved with rest
- Weakness of wrist and finger extensor muscles
The initial aim of treatment is to reduce associated pain and inflammation. Rest from aggravating activities is important. Treatment and management options include:
- Avoidance of aggravating activities
- Anti-inflammatory medication as recommended by a doctor or pharmacist
- Taping, braces or supports as indicated
- Physiotherapy- massage and mobilisations, ultrasound, ice therapy and stretches
- Development of a pain-free exercise program aimed at stretching and strengthening specific muscles around the elbow.
- Education and advice regarding technique correction for the aggravating activity.
A period of three to six weeks (at least) of physiotherapy should allowed prior to considering other options. If symptoms persist, a corticosteroid injection into the painful area may be considered to assist in reducing pain and inflammation. In this case, continuing the exercise program provided is still important. Surgery is a last resort treatment. Surgery generally involves removal of any damaged tendon and repair of any large tears in the tendon. Surgery will only be performed if conservative management over six to twelve months is ineffective.
Return to Activity
Tennis elbow will generally last for three to six months and longer in more severe cases. Most individuals (~90%) will respond well to conservative physiotherapy treatment and a full recovery is likely.