Many individuals with tennis elbow are involved in work or recreational activities that require repetitive and vigorous use of the forearm muscles. Some patients develop tennis elbow without any specific recognizable activity leading to symptoms.
Tennis elbow is a degenerative condition of the tendon fibers that attach on the bony prominence (epicondyle) on the outside (lateral side) of the elbow. The tendons involved are responsible for anchoring the muscles that extend or lift the wrist and hand.
Risk Factors/Prevention
Tennis elbow happens mostly in patients between the ages of 30 years to 50 years. It can occur in any age group. Tennis elbow can affect as many as half of athletes in racquet sports. However, most patients with tennis elbow are not active in racquet sports. Most of the time, there is not a specific traumatic injury before symptoms start.
Common Activities that can lead to “tennis elbow”:
- Recreational: Tennis, Racquetball, Squash, Fencing
- Occupational: Meat Cutting, Plumbing, Painting, Raking, Weaving
Symptoms
Patients often complain of severe, burning pain on the outside part of the elbow. In most cases, the pain starts in a mild and slow fashion and gradually worsens over weeks or months. Pressing on the outside part of the elbow or by gripping or lifting objects can increase the pain. Lifting even very light objects (such as a small book or a cup of coffee) can lead to significant discomfort. In more severe cases, pain can occur with simple motion of the elbow joint. Pain can radiate to the forearm.
To diagnose tennis elbow, tell the doctor your complete medical history. He or she will perform a physical examination.
- The doctor may press directly on the bony prominence on the outside part of the elbow to see if it causes pain.
- The doctor may also ask you to lift the wrist or fingers against pressure to see if that causes pain.
X-rays are not necessary. Rarely, MRI (magnetic resonance imaging) scans may be used to show changes in the tendon at the site of attachment onto the bone.
November 2004, AAOS
Repairing Tennis Elbow (Lateral Epicondylitis)
Treatment Options: Non-Surgical
In most cases, nonoperative treatment should be tried before surgery. Nonoperative treatment is successful in approximately 85 percent to 90 percent of patients with tennis elbow.
Pain relief is the main goal in the first phase of treatment. Your doctor may recommend a number of approaches for pain relief:
- Stop any activities that cause symptoms.
- Apply ice to the outside part of the elbow.
- Take acetaminophen or an anti-inflammatory medication for pain relief.
- Use counterforce braces and wrist splints. These can reduce symptoms by resting the muscles and tendons.
Symptoms should improve significantly within four weeks to six weeks.
If not, the next step is a corticosteroid injection around the outside of the elbow. This can be very helpful in reducing pain. Corticosteroids are relatively safe medications. Avoid repeated injections (more than two or three in a specific site).
After pain is relieved, the next phase of treatment starts with physical therapy. The doctor may want you to do physical therapy. This may include stretching and range of motion exercises and gradual strengthening of the affected muscles and tendons. Physical therapy can help complete recovery and give you back a painless and normally functioning elbow.
Modifying the activities that caused the problem can help make sure that symptoms do not come back. Treatment Options: Surgical
Surgery is considered only in patients who have incapacitating pain that does not get better after at least six months of nonoperative treatment.
The surgical procedure involves replacing the diseased tendon tissue with normal tendon tissue. The procedure can usually be performed under regional or general anesthesia without requiring an overnight stay in the hospital.
- Most commonly, the surgery is performed through a small incision over the bony prominence on the outside of the elbow.
- Recently, an arthroscopic surgery method has been developed.
So far, no significant benefits have been found to using the arthroscopic method over the more traditional open incision.
November 2004, AAOS
Recovering from Tennis Elbow Surgery (Lateral Epicondylitis)
Tennis elbow surgery is considered successful in approximately 90 percent of patients.
1 Week Post-op:
After surgery, the elbow is placed in a small brace and the patient is sent home.
About one week later, the sutures and splint are removed. Then exercises are started to stretch the elbow and restore range of motion.
2 Months Post-op:
Light, gradual strengthening exercises are started two months after surgery.
4-6 months Post-op:
You can normally return to athletic activity approximately four months to six months after surgery. Consult your doctor before returning to activity.