What is tennis elbow?

Tennis elbow, also known as lateral epicondylitis, is a painful condition affecting the outer side of the elbow. It is caused by repetitive hand motions involving the elbow joint and forearm muscles.

Dr. Ferdinand Runge originally described the pain around the lateral epicondyle of the humerus in 1873 under the name“writer's cramp.” Later, it was known as “washer women's elbow.” After it occurred in tennis, the term “tennis elbow” was coined in 1883. 

How does tennis elbow develop?

The forearm muscles are attached to your elbow at a small bony bump called the lateral epicondyle with the help of tendons. The bony bump is found on the outside of your elbow. The tendon is a strong, inelastic, but flexible cord of tissue fibres which connects the muscles to the bones. The purpose of the tendon is to transmit forces generated from the muscle to the bone to elicit movement.¹

If you perform repetitive hand movements involving the elbow joint, e.g., playing tennis, these bony bumps rub against the tendons repetitively. Due to constant rubbing, these tendons get small tears, which cause swelling and pain. As the condition progresses, in severe cases, the pain can make it difficult to lift even lighter objects, e.g. a sheet of paper, significantly affecting daily activities.

If you are involved in a profession that primarily requires repetitive hand movements, then developing tennis elbow can have a massive impact on your career. This can also cause psychological impacts, causing conditions like anxiety and depression, so it is important to identify this condition in the early stages and prevent it from progressing by taking necessary measures.

Notable sportsperson and legendary Cricketer Sachin Tendulkar suffered from Tennis elbow, which led him to take surgical measures to address this condition in 2005. Although the condition is known as tennis elbow, only 5% of people suffering from this condition are into racquet sports. 

Tennis elbow can occur in anyone who performs repetitive hand movements involving the elbow joint and forearm muscles, e.g. writers, painters, carpenters, sculptors.

In this article, let’s understand how prevalent this condition is in non-athletes and the causes behind it.

Prevalence of tennis elbow in athletes and non-athletes

One of the most common work-related disorders developing at the site of the elbow is Tennis Elbow.² It affects about 1-3% of the population.³ In the UK, the Netherlands, and Scandinavia, the incidence of lateral elbow pain in general practice is 4–7/1000 people a year.⁴

Tennis elbow is common in the age group between 30 to 50 and is found to be more common in people assigned male at birth.

As previously mentioned, although the condition is known as “tennis elbow”, only 5% of people suffering from this condition are into racquet sports. Approximately 50% of tennis players can expect to develop tennis elbow at some point during their career. It occurs mostly between the ages of 40-50, with 90% of players not having further recurrence once resolved. 

In one-third of the players, this will be severe enough to interfere with their daily living tasks.⁵ In half of these cases, tennis players develop symptoms due to various factors, including poor swing technique or use of a heavy racquet.⁶ 

In another study conducted on 540 workers in the engineering industry, designed to assess the prevalence of Tennis elbow and its relationship to work factors, it was observed that out of 540 workers, 40 suffered from this condition. Among these 40 workers, work was found to be the probable cause in 35%, tennis in 8% and other leisure activities in 27% of the patients. No cause was found in the remaining 30%. There was no correlation with sex, while a significant correlation was found with age, the incidence increasing with advancing age.⁷

Causes of tennis elbow

Although there is no one particular reason which can be pinpointed as the cause of tennis elbow, below are observations which have been found in people suffering from Tennis elbow, which could be responsible for developing this condition.

• Repetitive hand movements
• Incorrect handling or gripping of the tools, e.g. racquets, garden tools
• Working for long hours without taking breaks
• Weak muscles
• Heavy tools use
• Advancing age
• Sudden increase in the movements, e.g. taking up sports during holiday seasons

Non-athletic professions that can cause tennis elbow

Below are some non-athletic professions and activities that can be associated with tennis elbow:

• Holding a paintbrush for a prolonged period while doing paintwork
• Using a computer mouse without breaks for long periods
• Holding and operating heavy tools in the plumbing occupation
• Writing or typing for a prolonged time
• Sculpting for a long time in sculpture
• Using a knife for cutting, especially a butcher 

Symptoms of tennis elbow

• Pain in the forearm while lifting, twisting or pulling action, e.g. opening a car door, opening a jar, gripping a tool
• Pain is experienced even when lifting lighter objects like a sheet of paper, in severe cases
• In milder cases, the pain subsides with rest
• Pain lasting even after quitting the movements 
• Swelling/redness on the elbow
• Restricted elbow movements
• Stiffness, particularly in the mornings
• Difficulty in keeping hold of objects such as a paintbrush or a tennis racquet

Prognosis

Tennis elbow can last for several months or years. Generally, it resolves with rest and pain-relieving medications, but in a minority of people, symptoms persist for 18 months to 2 years, and in some cases for much longer.⁸

Generally, Tennis elbow responds well to the treatment measures and resolves without any long-term complications. It is important to address these concerns with the right treatment promptly. If left untreated, the injured tendons fail to heal, leading to damage to the tendon tissue, which requires surgical intervention to resolve the condition.

Treatment 

• Anti-inflammatory gels for local application or over-the-counter NSAID tablets, including ibuprofen to be taken orally, which help to reduce pain and inflammation
• Stretching exercises to relieve tension in the muscles
• Massage to increase blood circulation, helping to relieve inflammation and pain
• Ultrasound therapy with high-frequency sound waves, which aid in increasing blood circulation, helping to resolve pain and inflammation
• Support for the forearm muscles and the elbow with the use of splints or braces
• Steroid injections are sometimes used when immediate relief is required (in case of a sports match or exam but they should only be used where the benefits outweigh the risks, as the long-term outlook of steroid use is not favourable for this condition
• Reducing the repetitive hand movement which causes the pain
• Taking regular breaks from work also helps to reduce the strain and improve the condition 

Summary

Tennis elbow, also known as lateral epicondylitis, is a painful condition affecting the outer side of the elbow. It is caused by repetitive hand motions involving the elbow joint and forearm muscles.

Due to constant rubbing, these tendons get small tears, which cause swelling and pain. As the condition progresses, in severe cases, the pain can make it difficult to lift even lighter objects, e.g. a sheet of paper, significantly affecting daily activities. 

Tennis elbow can occur in anyone who performs repetitive hand movements involving the elbow joint and forearm muscles, e.g. writers, painters, carpenters, sculptors. Tennis elbow can last for several months or years. Generally, it resolves with rest and pain-relieving medications, but in a minority of people, symptoms persist for 18 months to 2 years, and in some cases for much longer, needing surgical intervention.