Tennis elbow / Lateral epicondylitis

What is tennis elbow or lateral epicondylitis?

Tennis elbow or lateral epicondylitis is an extremely common injury that originally got its name because it is a frequent tennis injury, appearing in a large proportion of tennis players. Nevertheless it commonly manifests in a vast proportion of people who do not play tennis at all.

Lateral epicondylitis occurs most commonly in the tendon of the extensor carpi radialis brevis muscle at approximately 2cm below the outer edge of the elbow joint or lateral epicondyle of the humerus bone.

Specific inflammation is rarely present in the tendon but there is an increase in pain receptors in the area making the region extremely tender.

Signs and symptoms of tennis elbow / lateral epicondylitis

Pain about 1-2 cm down from bony area at the outside of the elbow (lateral epicondyle)
Weakness in the wrist with difficulty doing simple tasks such as opening a door handle or shaking hands with someone.
Pain on the outside of the elbow when the hand is bent back (extended) at the wrist against resistance.
Pain on the outside of the elbow when trying to straighten the fingers against resistance.
Pain when pressing (palpating) just below the lateral epicondyle on the outside of the elbow..

Other injuries and conditions with similar symptoms :

The symptoms for this injury are very similar to Entrapment of the radial nerve which we recommend you also have a look at.
It is important to have the neck examined as well, as elbow pain can be referred from problems in this region. See the neck pain page for further details.

Causes of tennis elbow

Tennis elbow is often caused by overuse or repetitive strain caused by repeated extension (bending back) of the wrist against resistance. This may be from activities such as tennis, badminton or squash but is also common after periods of excessive wrist use in day-to-day life

Tennis elbow may be caused by:

A poor backhand technique in tennis.
A racket grip that is too small.
Strings that are too tight.
Playing with wet, heavy balls.
Repetitive activities such as using a screwdriver, painting or typing.

Two types of onset are commonly seen:

Sudden Onset: Sudden onset of tennis elbow occurs in a single instance of exertion such as a late back hand where the extensors of the wrist become strained. This is thought to correspond to micro-tearing of the tendon.

Late Onset: This normally takes place within 24-72 hours after an intensive term of unaccustomed wrist extension. Examples may be a tennis player using a new racket or even a person who's spent a weekend doing DIY.

Tennis elbow management and treatment

No single treatment has been shown to be totally effective, however a combination of the treatments below are known to resolve tennis elbow over time. Each individual will react differently to different treatments.

What can the athlete do?

Apply ice or cold therapy to the elbow (15 mins up to six times a day). This will help reduce pain and inflammation if present.
Rest - an extremely important component in the healing of this injury.
Wear a brace or support (Play video) to protect the tendon whilst healing and strengthening, particularly when returning to playing / equivalent. The brace should not be put on the painful area but rather approximately 10cm down the forearm.
As with all soft tissue injuries a comprehensive rehabilitation program should be carried out.

What can a sports injury specialist or doctor do?

Rule out neural (nerve) involvement
Advise on pain control-such as NSAID's like Ibuprofen.
Apply ultrasound or laser treatment to help reduce pain and inflammation as well as stimulate healing.
Use manual therapy treatments such as massage therapy, myofacial release and/or transverse friction techniques across the tendon
Try acupuncture which has been shown to be extremely effective for tennis elbow.
Advise on rehabilitation to return the athlete to full fitness.
Provide advice on neural stretching exercises if nerve tissue involvement is suspected
Give a steroid injection to reduce inflammation if present
Identify and correct any predisposing factors which lead to the onset of tennis elbow. Your tennis coach should also be able to provide some advice with regards your backhand technique, grip and racket size.
Operate - if conservative treatments have failed for about a year then this may be considered.