What Is Tennis Elbow (Lateral Epicondylitis)?

Overview

The elbow joint comprises 3 bones known as the upper arm bone: the humerus, and two forearm bones (radius and ulna). There are bony bumps at the end of the humerus which several muscles are attached to and the bony bump on the outside of the elbow is known as lateral epicondyle. A Tendon is a tissue that connects the muscles to the bones. 

Tennis elbow is a painful condition caused by the overuse of the tendon (extensor carpi radialis brevis) leading to inflammation, degeneration and tearing of the forearm muscles and tendons around the lateral epicondyle bone (hence the medical term lateral epicondylitis). Repetitive use of the arm makes the muscles weaken and cause pain while bending or straightening or trying to grasp or lift any items.¹ 

Tennis elbow commonly affects tennis players as suggested by its name but can also affect anyone who carries out repetitive activities of the wrist, elbow and forearm muscles. 

Causes

Tennis elbow is usually caused by straining of the forearm muscles and subsequent tendon injury and inflammation. Some of the causes are: 

• Overuse: Repetitive use of the hand in various professions such as tennis (sports), musicians, dentists, chefs, mechanics, and also in activities like typing and sewing can cause strain to the wrist and elbow
• Activities: Many people can be affected by tennis elbow because of the repetitive activity and weight lifting. People painting with a brush or roller for the first time or after a long time can strain their wrists and elbows
• Age: Any age person can be affected by tennis elbow but mostly people between 30 - 50 years.
• People with weak shoulder and wrist muscles can be affected by tennis elbow 

Symptoms

The most common symptoms are pain and discomfort in the elbow while using the arm. The symptoms change according to the severity of the condition and usually the dominant arm is affected mostly. Some of the other symptoms are: 

• Pain in the outer elbow which travels to the forearm and the wrist
• Burning sensation on the elbow
• Pain increases during the nighttime
• Weakness felt while holding a pen or any objects
• Stiffness while extending the arm
• Swelling in the elbow
• Pain while twisting or bending the arm 

Diagnosis

Your doctor will perform a thorough physical examination of your arm and may ask questions to know how the symptoms have developed and will enquire about any history of accidents that occurred to the elbow. Other history of illness such as rheumatoid arthritis or illness affecting the nervous system may be important too. The diagnosis of tennis elbow usually can be made based on this information alone, however, if there is suspicion of other more complicated disease processes (such as fracture) then imaging tests such as CT scans (computed tomography) or MRI scans (magnetic resonance imaging) may be requested by your doctor.

Treatment and management

Usually, tennis elbow can be treated conservatively, but in severe cases, surgery may be needed.^2,3,4

1. Rest: Avoid or stop doing activities that strain the forearm muscles and tendons. Applying ice packs reduces elbow inflammation
2. Braces: wearing a brace or splint, supports the elbow and decreases strain on muscles and tendons. This will reduce the symptoms⁵
3. Medications: According to the severity of the condition, your doctor will prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to reduce the pain and inflammation
4. Steroid injections: Injectable corticosteroids can be considered by your doctor if the symptoms are unsettled despite other initial measures njection is administered in the painful area to reduce the pain and symptoms⁵
5. Physiotherapy: The doctor may suggest doing physiotherapy to restore the movement to the affected area. Physiotherapists may suggest some therapy techniques along with massage and some muscle strengthening exercises which help the arm to relieve from the stiffness and increase the blood flow to the arm. This reduces the pain and symptoms
6. Extracorporeal shockwave therapy: This is a non-invasive treatment where the shockwaves are passed through the skin and promote the movement of the affected area. Number of sessions depends on the severity of the disease^6,7
7. Surgical treatment: Surgeon performs an open surgery where the affected muscle is removed and a healthy muscle is reattached back to the bone

Prevention

1. Stop doing activity that causes pain
2. Use lightweight tools while working which reduces the strain on the arm
3. Take rest while doing repetitive work
4. Perform muscle-strengthening exercises to improve the blood flow and movement of the arm
5. Wear an elbow brace while playing sports or doing any work to reduce the strain or to keep symptoms from worsening

FAQ's

How to relieve the symptoms of tennis elbow?

• Taking rest relieves the elbow pain
• Taking painkillers reduces pain and inflammation
• Applying ice packs reduces pain and inflammation

What triggers tennis elbow?

Tennis elbow is usually caused by the overuse or repetitive movement of the forearm leading to inflammation of the muscles attached to the outer bony lump of the elbow joint. 

Can the tennis elbow go away?

Tennis elbow can go away but it is a slow process. Full recovery has been seen in 90% of cases within a year but this can range from 6 months to 2 years. Regular muscle strengthening exercise will improve blood flow and healing leading to improving symptoms. Does tennis elbow come suddenly?

The symptoms of tennis elbow appear slowly and usually after long repetitive strain to the elbow.

When should I consult the doctor?

You should see your doctor when there is difficulty in moving the arm and doing day-to-day activities. You should also seek help when swelling increases and there is pain at the slightest touch.

Summary

Tennis elbow is a painful condition causing inflammation, degeneration and injuries of the forearm muscles and tendons caused by overuse. Repetitive use of the arm makes the muscles weaken and causes pain while bending, straightening, or trying to grasp or lift any items. Tennis elbow commonly affects tennis players but can also affect anyone who performs repetitive activities of the wrist, elbow joints and forearm muscles. Tennis elbow usually only needs nonsurgical treatments, but in severe cases, surgery intervention may be needed.