What is Tennis Elbow (medical term lateral epicondylitis)? It is a common injury that causes pain on the outside of the elbow.
Despite it's name, this condition is not only seen in tennis players but is also seen in other sports or recreational activities that involve repetitive stress on the muscles around the elbow, such as heavy lifting or decorating.
The injury can be very troublesome to treat, especially if it becomes chronic, so it is very important to obtain an accurate diagnosis as early as possible. Tennis elbow can either develop very suddenly (acute) or over a period of days/weeks and more gradually (chronic).
The main symptom is pain about 1 to 2 cm down from the bony part on the outside of the elbow, known as the lateral epicondyle. In addition, there may be associated weakness in the muscles around the forearm and wrist and this may cause difficulty in performing simple tasks such as opening a door handle or shaking hands with someone.
A doctor or professional therapist may perform a number of assessment tests to help diagnose lateral epicondylitis.
Read more on assessment tests and diagnosis.
What causes tennis elbow? It is usually an over use injury and most commonly occurs at the junction where the tendon of the 'extensor carpi radialis brevis' muscle inserts into the lateral epicondyle of the humerus (bony bit on the outside of the elbow near the 'funny bone'). In this area there are a large number of pain receptors making this region particularly tender to touch.
Acute injuries occur immediately after an activity such as hitting a backhand shot in tennis with poor technique. The extensor muscles on the back of the forearm (wrist extensors) become suddenly overloaded causing micro tears of the tendon where it attaches to the elbow.
Chronic injuries on the other hand normally develops over a period of days/weeks and usually follows bouts of intense exercise/activity that the patient is unaccustomed to, such as lifting heavy boxes when moving house.
The medical term is lateral epicondylitis but this can be misleading as the 'itis' on the end of the word implies that there is inflammation in the area but in most cases this is not true because most of the injuries are chronic or longstanding and therefore the inflammatory stage has finished.
Read more on the causes and prevention of Tennis Elbow.
Treatment for involves reducing symptoms of pain and inflammation through rest and applying ice or cold therapy then gradually increasing the load through the elbow through exercises to a point where normal training and competition can be resumed.
Wearing a tennis elbow brace or support can help reduce the strain on the tendon enabling healing to take place. Sports massage can be of benefit and a doctor may prescribe medication such as Ibuprofen to help reduce symptoms.
In addition acupuncture, injections of corticosteriods, botox and autologogous blood injection may alse be prescribed.
Read more on tennis elbow treatment
Both stretching and strengthening exercises are important and provide the foundation of a rehabilitation program. The exercises should be performed as soon as pain allows and then continued until and after full fitness has been achieved.
Wrist extension stretches and exercises are the most important with the aim of gradually increasing the load transmitted through the tendon and its attachment whilst also being within the limits of pain. Isometric (also known as static exercises) are done first and involve contracting the muscles without actually moving the wrist. They should only be started once the initial pain and inflammation has settled down.
Read more on tennis elbow exercises.
See our interview with Mr Elliot Sorene, Consultant Surgeon who describes when surgery for Tennis and Golfers elbow may be indicated and which patients are most suitable.