Tennis Elbow

Tennis elbow occurs when there is a problem with the tendons that attach to the outside of the elbow. These tendons are the attachment of the muscles that function to cock the wrist back. Specifically, the extensor carpi radialis brevis has been implicated in causing the symptoms of tennis elbow. This muscle attaches to a part of the elbow bone called the lateral epicondyle, thus giving tennis elbow the medical name 'lateral epicondylitis.'

Tennis elbow is not simply an "inflammation" of these tendons. The problem is thought to be a degenerative process as a result of repetitive use. This process occurs when microscopic tears are incompletely healed within the tendon.

Tennis elbow is most commonly seen in two groups of people:

• Manual Laborers
  People who work with their hands are at greater risk of developing tennis elbow. Jobs that may lead to tennis elbow include plumbers, painters, gardeners, and carpenters.
• Sports Participants
  Sports participants, especially racquet sport players, are prone to developing tennis elbow. About a third of amateur tennis players experience tennis elbow at some point in their careers. In addition to racquet sports, tennis elbow is seen in golfers, fencers, and other sports participants.

What caused your tennis elbow?

Patients with tennis elbow experience pain on the outside of the elbow that is worsened by grasping objects and cocking back the wrist. The most common symptoms of tennis elbow are:

• Pain over the outside of the elbow
• Pain when lifting objects
• Pain radiating down the forearm

The pain associated with tennis elbow usually has a gradual onset, but it may also come on suddenly. Most patients with tennis elbow are between the ages of 35 and 65 years old, and it affects about an equal number of men and women. Tennis elbow occurs in the dominant arm in about 75 percent of people.

X-rays of patients who have the diagnosis of tennis elbow are almost always normal. An MRI scan is also often normal, although in some individuals the affected tendon may show some abnormal changes. Other tests, such as nerve conduction study, are sometimes conducted if there is confusion about the diagnosis.

Other causes of pain over the outside of the elbow include instability of the joint, elbow arthritis, and radial tunnel syndrome. The symptoms of these conditions are usually distinct, but in some cases they can be confusing. These conditions should be considered if the symptoms are not typical for tennis elbow or if the patient does not respond to treatment.

The following symptoms should be discussed with your doctor before initiating any treatment:

• Inability to carry objects or use your arm
• Elbow pain that occurs at night or while resting
• Elbow pain that persists beyond a few days
• Inability to straighten or flex your arm
• Swelling or significant bruising around the joint or arm
• Any other unusual symptoms

Treatment of tennis elbow always begins with simple steps. Most all individuals will respond to simple treatments, given sufficient time. It is usually best to begin treatments in a stepwise fashion, advancing to the next treatment only if one fails to alleviate your symptoms. It is also important to remember that most patients take a few months from the onset of symptoms to resolution of symptoms -- it is rarely an overnight cure.

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A small percentage of patients diagnosed with tennis elbow will ultimately require surgical treatment. Patients may consider surgery if more conservative treatments are not effective after a period of six to 12 months.

Sources:

Dines JS, Bedi A, Williams PN, Dodson CC, Ellenbecker TS, Altchek DW, Windler G, Dines DM. "Tennis injuries: epidemiology, pathophysiology, and treatment" J Am Acad Orthop Surg. 2015 Mar;23(3):181-9.

Calfee RP, Patel A, DaSilva MF, Akelman E. "Management of lateral epicondylitis: current concepts" J Am Acad Orthop Surg. 2008 Jan;16(1):19-29.

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