What is Tennis Elbow?

Tennis elbow is the popular term for the medical diagnosis of epicondylitis of the elbow. The underlying problem is inflammation of the tendons (ends of muscles) that attach to either the outside or inside aspects of the elbow. It is also known as tendinitis. It may be classified as either lateral (outside) or medial (inside) tennis elbow depending on which tendons are involved. The term tennis elbow is misleading as it is also quite common among non-athletes and is often occupationally related. Patients whose occupations require repetitive and/or stressful forearm activity are especially at risk. Tendinitis may also result from a specific trauma to the elbow but at times no inciting event is identified.

Most commonly the inflammation involves the tendons on the outside of the elbow where they attach to what is known as the lateral epicondyle. These tendons extend or lift the wrist and fingers upwards. This process results in tears and microtears within these tendons and is directly related to activities that stress the wrist and fingers. It is most commonly seen between the ages of 30 and 50.

Signs and Symptoms of Tennis Elbow

Patients with tennis elbow frequently complain of pain on the outside of the elbow which is exacerbated with strenuous activities such as lifting, pushing or carrying. In more severe cases even light activities of daily living produce discomfort such as shaking hands, turning a key in a door and hair grooming. The affected muscles span from the elbow to the wrist; therefore, pain and a sense of weakness may be experienced down the back of the forearm as well as at the elbow.

How is Tennis Elbow Diagnosed?

The physician's diagnosis of tennis elbow is made by taking a thorough history, physical examination and plain x-rays. Your doctor will evaluate the point of maximal tenderness, range of motion and strength of the elbow, wrist and fingers. Specific maneuvers are performed to duplicate your symptoms such as lifting your wrist upwards against resistance. Occasionally, an injection of local anesthetic is employed as a diagnostic test to evaluate pain relief.

Common Treatments for Tennis Elbow

Tennis elbow usually responds to nonsurgical treatment directed at relief of pain and inflammation followed by promotion of healing. Treatment is begun with an initial period of rest aided by a wrist splint to relax the muscles that move the wrist and fingers. Eliminating the activity that aggravates the condition is important. Anti-inflammatory medications and a gentle physical therapy program aimed at stretching and then graduated strengthening of the hand and forearm muscles may also be beneficial. If you do not respond to these measures your physician may suggest the use of local steroid and anesthetic injections in order to alleviate the pain and eliminate the inflammation. As healing occurs, a forearm support band can be prescribed for use during the sport or occupational activity that provokes pain. Also, adjustments in the occupational or athletic equipment such as changes in racquet size, weight or composition, technique or environment may be indicated to prevent symptoms from returning.

Surgical treatment is required when patients fail to respond to non-operative treatment, about 5-10% of cases. The surgery is usually performed on an outpatient basis and may be under general anesthesia or regional (limited) anesthesia. It consists of an incision along the epicondyle with excision and repair of the torn tendon. A splint is required postoperatively for a few weeks followed by a progressive strengthening exercise program.

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