Tennis Elbow / Lateral Epicondylitis

Tennis elbow or lateral epicondylitis is a common injury causing pain on the outside of the elbow. Despite it's name, this condition is not commonly seen in tennis players but more in work related elbow injuries particularly where repetitive stress is involved.

Tennis elbow symptoms can be similar to those of other elbow injuries so it is important to get a correct diagnosis early on.

Tennis Elbow Symptoms:

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.

See tennis elbow diagnosis video for more information on how tennis elbow is diagnosed.

Injuries 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 for further details.

What is Tennis Elbow?

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.

Causes of tennis elbow

Overuse or repetitive strain caused by repeated extension (bending back) of the wrist against resistance. Or gripping heavy objects like a manual screw driver, weight training or handling bricks.
A poor backhand technique in tennis. If the wrist is bent when striking a back hand the huge forces are transferred through the tendons to the elbow rather than through the entire arm.
A racket grip that is too small. This will make the muscles work harder increasing the forces through the tendon.
Strings that are too tight. More shock and energy will be transmitted through the forearm from the ball.
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 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 tennis elbow brace 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 of tennis elbow exercises 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 tennis elbow exercises 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.
Try Extracorporeal Shock Wave Therapy (ESWT).
Operate - if conservative treatments have failed for about a year then tennis elbow surgery may be considered.