Elbow lateral epicondylitis, also known as tennis elbow, occurs when the arm is used too often and is associated with pain. The most common risk factor for tennis elbow is sport activities, with racquet sports like tennis being particularly conducive to the condition.

Tennis elbow is accompanied by tendon inflammation in the forearm, which results from overuse of the same arm muscles or the tendons supporting those muscles in this part of the arm. The pain associated with tennis elbow is generally localized to the elbow.

 

Tennis Elbow

Anatomy

3 bones make up the elbow: the humerus, which is located at the top of the arm, and the radius and ulna, which are located in the forearm. The elbow joint is held together by muscles, ligaments, and tendons. The epicondyles consist of two pumps near the elbow.

Both the muscles and tendons of the forearm are implicated in tennis elbow. The forearm muscles attaches to extensor tendons that extend the fingers. These extensor tendons connect with the epicondyle on the outside of the elbow. Extensor Carpi Radialis Brevis (ECRB) is the tendon most commonly involved in tennis elbow.

 

Elbow Muscles

Cause

If the ECRB tendon becomes weak from overuse, tears can develop along near the epicondyle, leading to pain and inflammation. One common cause is repetitive tennis groundstrokes.

The location of ECRB may make it particularly vulnerable to injury. Specifically, the muscle can rub the spicondyles when the elbow bends or straightens, which causes wear on the muscle.

Elbow Lateral Epicondylitis

Though athletes are an obvious patient population for tennis elbow, several non-athletes suffer this condition as well, as any repetitive, vigorous forearm motion puts one at risk for tennis elbow. Cooks, painters, auto-workers, plumbers, butchers and carpenters are particularly prone to developing tennis elbow.

People of all ages can get tennis elbow, though 30- to 50 is the most common time to develop it.

For athletes using racquets, ensuring proper stroke technique and sturdy equipment can reduce the risk of developing tennis elbow.

Symptoms

Tennis Elbow Symptoms

Rather than occurring as a result of a specific injury, tennis elbow usually begins with mild pain but develops gradually over weeks and months.

The most common symptoms of tennis elbow are pain and/or burning in the outer portion of the elbow and weakened grip strength. If you continue to use your forearm, symptoms are likely to get worse. Because tennis elbow usually occurs as a result of overuse, any activity that involves forearm movement can exacerbate symptoms. Patients should thus avoid these types of activities. It is most likely that this condition will arise in your dominant arm.

Treatment

Non-surgical treatments work for over 80% of patients with this condition. Some non-surgical options are:

Rest: Rest is needed for every arm with this condition. Heavy lifting and participating in sports must be ceased for a number of weeks.

Anti-inflammatory medicines: these can be utilized to reduce pain and swelling.

Equipment check: Ensuring that your equipment is not facilitating arm problems is something that may be suggested by your doctor. It’s important that athletic gear and equipment fits properly. For example, more stable racquets and racquets with looser strings can prevent forearm stress.

Physical therapy: Exercise can strengthen the forearm. For example, the wrist stretching exercise with elbow extended shown below can help your forearm heal.

Your therapist may also promote healing with other non-surgical techniques.

Stretching elbow

Brace: Your tennis elbow symptoms may be relieved by a brace that rests on your forearm. The brace provides rest for the arm and can thereby reduce symptoms.

Counterforce brace

Injections of steroids: Steroids like cortisone are anti-inflammatory medicines. By injecting steroids in your arm, your doctor can reduce inflammation and associated symptoms.

PRP: Platelet-Rich Plasma is a relatively new treatment option that is beneficial in chronic tendon conditions such as tennis elbow. PRP is administered by injecting a solution of the patient’s own blood that is rich in growth factors into the arm. Because growth factors provide strength and growth, this treatment can stimulate healing.

Surgical Treatment

If your symptoms do not improve with nonsurgical treatments, you may need elbow surgery. Most of these surgical procedures involve removing torn or inflamed tendon from the elbow to attach the tendon to bone. Surgeries are 80-90% successful.

Open surgery: This procedure, which is the most common way to approach tennis elbow, is usually an outpatient surgery and involves an incision over the elbow.

Arthroscopic surgery: Arthroscopic surgery is a less invasive surgery that is performed with smaller incisions and tiny instruments. This is also a same-day or outpatient procedure.

 

Tennis Elbow Surgery

Surgical risks:

There are some risks with tennis elbow surgery. Some potential risks are: loss of strength and flexibility, nerve or damage to blood vessels, and infection. If complications arise, rehabilitation may take longer and further surgeries are possible.

Rehabilitation

After surgery, you will have to keep your arm still. This will be facilitated with a splint. The split and sutures can be removed after about a week.

Once the splint is gone, elbow exercises should be started to restore flexibility. Exercises to improve strength should be started about 2 months later.

You will probably be able to resume athletics around 6 months after your procedure. The specific timing will be up to you and your orthopedic doctor.