Tennis Elbow (Lateral Epicondylitis)

Common Symptoms of Tennis Elbow

The primary symptom of tennis elbow is a pain on the outer part of the elbow. This discomfort can vary from a mild, occasional twinge to a persistent, severe pain that may disrupt sleep. Painful symptoms are often noticed during physical activities requiring lifting, bending of the arm, or wrist motions such as when gripping objects.

In addition, individuals with tennis elbow may experience the following:

• Tenderness or swelling around the elbow
• A sensation of pain that radiates into the forearm
• Difficulty or discomfort when trying to fully straighten the arm
• Forearm muscle stiffness
• Weak grip strength
• Pain worsening with wrist motion

The symptoms typically develop slowly and can worsen over a period of weeks or months. Initially, the pain may be slight but can become more intense over time, even if no single injury is noted at the onset.

Common Causes of Tennis Elbow

Contrary to popular belief, tennis elbow doesn’t primarily affect athletes and tennis players; in fact, over 90% of those who suffer from it are not involved in racquet sports.

Repetitive arm movements, often found in certain professions or activities, can exhaust the forearm muscles, placing excessive stress on the tendons. This stress can cause the tendons to become inflamed, resulting in tennis elbow.

Common causes involve motions that require loaded and repeated gripping or wrist activities. The extensor carpi radialis brevis (ECRB), a forearm muscle, typically bears the brunt of such movements.

Activities that can cause tennis elbow:

• Loaded Gripping
• Repeated Wrist Extension (the movement of the hand and wrist that increases the angle between the back of the hand and the forearm)
• Radial Deviation (motion that brings your wrist closer to the thumb,)
• Forearm Supination (rotational movement of the forearm that results in the palms facing upward or forwards, depending on the position of the arms)

Besides overuse, other factors of tennis elbow include:

• Poor arm movement, mechanics, or technique
• Inadequate equipment

Diagnosis of Tennis Elbow

Tennis elbow is identifiable through specific symptoms and physical exams by a healthcare provider.

During the diagnosis, the provider will assess symptoms, usually without a single injury event to pinpoint. The examining physician will look for tenderness in the lateral epicondyle, the area where the forearm muscles attach to the bone using tendons, and they might test the pain response while the patient extends the wrist against resistance.

When necessary, diagnostic tests can confirm the condition:

• X-rays: To exclude bone-related issues.
• MRI: To visualize tendon damage.
• CT Scan or Musculoskeletal Ultrasound: For a detailed view of the elbow’s soft tissues.

The gradual onset of symptoms distinguishes tennis elbow from acute injuries, guiding treatment options that range from exercise to surgery for severe cases.

Treatment options for tennis elbow

Various treatment options tailored to the severity and duration of the condition are available. The main aim of these treatments is to alleviate pain, promote healing of the elbow tendon, and restore normal function. Here’s an overview of the various treatment possibilities for those struggling with this condition.

Non-surgical treatment options

Physical therapy plays a pivotal role in treating tennis elbow, with the goal of strengthening forearm muscles and increasing flexibility. Physical therapists guide patients through exercises designed to stretch and gradually strengthen the tendons and muscles of the forearm. In most cases, you do not need a prescription or referral from your doctor to see a physical therapist. That means if you’re experiencing pain, you can head straight to physical therapy.

Wearing braces is another common non-surgical option. An elbow brace or a wrist splint can help to rest the muscles and tendons, providing support and minimizing stress on the injured area.

Over-the-counter medications, such as NSAIDs (non-steroidal anti-inflammatory drugs) and acetaminophen, are often recommended to manage pain and inflammation.

It’s noteworthy that about 80% to 95% of patients find relief through nonsurgical treatments.

For some individuals who do not see relief from physical therapy, treatment may also include corticosteroid injections to reduce inflammation, or extracorporeal shock wave therapy to stimulate healing.

Surgical treatment options

When conservative treatments prove insufficient after an adequate period, surgical intervention may be considered. The primary objective of surgery is to remove the damaged portion of the tendon. This is generally followed by reattaching the undamaged portion of the tendon back  to the bone.

There are two main surgical approaches: open surgery and arthroscopic surgery. Open surgery involves creating an incision over the elbow to directly access and repair the affected tendon. It’s a common and traditionally favored method. Arthroscopic surgery, a less intrusive option, employs small incisions and miniature instruments for repair, usually allowing for a more rapid recovery.

Both surgical options are typically outpatient procedures, though full recovery can take several months and will most likely involve post-operative physical therapy. The decision to undergo surgery hinges on the severity of the injury, the overall health of the patient, and their personal circumstances.

Preventing Tennis Elbow

Lifestyle changes to prevent and manage tennis elbow

Tennis elbow can affect anyone who engages in repetitive wrist and arm motions, such as athletes, DIY enthusiasts and musicians. The good news is, incorporating some simple lifestyle changes can help prevent and manage the condition, minimizing the risk of discomfort and severe pain.

These changes can include taking time to warm up and stretch before activities that put strain on your elbow, improving arm strength and flexibility of your forearm muscles, and ensuring proper techniques and ergonomic modifications are used during activities.

Including rest and recovery periods in your routine can be indispensable for allowing inflamed tendons (and extensor carpi radialis brevis) to heal. And when necessary, using protective equipment can support your elbow during vulnerable periods. Embracing these proactive strategies is a key step in maintaining elbow health and function.

Ergonomic modifications

A mindful approach to daily and professional activities can help manage and reduce the risk of tennis elbow. Ergonomic modifications to tools and sports equipment can greatly decrease repetitive strain.

For instance, adding padding to increase the gripping surface of a tool can lessen the tension through the forearm muscles and elbow.

Dual-handed wielding of heavy tools can distribute load more evenly, while specially padded hammers can absorb shock better.

In sports like tennis, selecting a racket that suits one’s strength and style — with factors such as grip size, string tension and weight considered — can make a significant difference. For golfers, applying oversized grips on clubs can ease the strain transferred to the elbow. These adjustments are not just for comfort; they’re critical in long-term prevention and management of elbow tendinopathies.

Warm-up and stretching

Warming up and stretching are essential to protecting against tennis elbow. Before engaging in any sport or activity that involves the elbow, a dynamic and sport-specific warm-up is recommended. Stretching increases blood flow to the muscles, boosting flexibility and movement efficiency, and decreasing the likelihood of strains and micro-injuries. Simple wrist and elbow stretches before and after activities elongate and condition the tendons and muscles, helping keep them supple and resilient.

Importance of seeking proper medical care

When experiencing elbow pain or discomfort, it’s essential to understand the importance of seeking proper medical care. Early intervention is critical, as symptoms like weakness, a burning sensation, and difficulty with simple tasks such as lifting objects may indicate elbow tendinitis, also known as lateral epicondylitis or more commonly referred to as “tennis elbow.”

Seeking prompt medical attention ensures a quick diagnosis and the start of an effective treatment plan. Delaying a visit to a healthcare provider not only prolongs the pain but can also lead to further complications requiring more invasive interventions. Muscle to bone connections in the elbow are subject to stress, and repetitive movements, such as those in racquet sports or everyday activities, can exacerbate the issue.

A tailored treatment approach by a physical therapist can significantly alleviate symptoms and help to restore normal elbow health and function.

In summary, if you’re experiencing symptoms:

• Seek care promptly
• Get a proper diagnosis
• Rule out other conditions
• Start an effective treatment plan
• Avoid further complications

Ignoring symptoms can impede the healing process and overall well-being. Remember, early and tailored care is paramount for recovery.

Potential complications of untreated tennis elbow

When tennis elbow is left untreated, the symptoms can worsen. In rare, severe cases, there is potential for tendon rupture due to continuous use of the affected elbow before adequate healing has occurred.

Untreated tennis elbow can evolve into chronic pain and create persistent weakness in the arm. This can lead to a vicious cycle where the elbow’s functions are increasingly compromised, and everyday activities become painful or challenging to perform. Without proper treatment, individuals may experience prolonged discomfort, which can interfere with both professional responsibilities and personal hobbies.

Early intervention and proper management are critical to avoid these complications  of untreated tennis elbow, emphasizing why seeing a healthcare provider and seeking physical therapy is necessary for recovery.

When to see a provider

Consult a healthcare provider when you notice persistent elbow pain, suspect an elbow injury, or if daily activities like gripping or lifting become challenging. Such symptoms warrant a thorough evaluation for a proper diagnosis.

Prompt medical attention not only opens up a variety of treatment options but also prevents the condition from worsening. Approximately 3% of Americans are affected by tennis elbow annually. Recognizing the symptoms early and consulting with a provider can stave off severe pain and longer-term complications, ultimately enhancing recovery outcomes. The sooner you seek treatment, the sooner you can resume daily activities comfortably.