Tennis Elbow | Lateral Epicondylitis

Tennis elbow, medically called ‘lateral epicondylitis’ is an overuse injury that can affect your elbow.

Tennis elbow is caused by (no surprises) playing tennis. But tennis is not the only cause, there are many other activities that can cause tennis elbow.

The pain of tennis elbow is usually located around the outside of your elbow. Although the pain can also spread towards your forearm and wrist.

Symptoms

The symptoms of Tennis Elbow include:

Pain 

  • the pain may radiate from the outside of your elbow into your forearm and wrist
  • this pain is worsened when you extend your wrist
  • it may worsen over weeks or months

Weakness

  • you may experience weakness of your forearm muscles

Activites 

  • A painful grip during certain activities, such as shaking hands or turning a doorknob
  • You may have trouble holding objects, such as a coffee cup

Causes

Tennis elbow is an overuse injury. 

The muscles and tendons of your forearm that allow you to straighten and bend back your wrist and hand are attached to the outside of your arm bone (your humerus). With repetitive use and stress, some micro tears and inflammation of those tendons may occur. 

Your body tries to heal those tears, which normally can take some time. 

The activities that can cause these tears include:

  • playing tennis
    • particularly, repeated use of the backhand stroke with poor technique
  • using tools
    • plumbing 
    • painting, 
    • raking

Risk Factors

Tennis elbow usually effects people between the ages of  30 to 50 , but can affect any person that uses particular repetitive motions of the wrist.

If you smoke, you are also at higher risk of developing tennis elbow.

Investigations

Tennis Elbow is can usually by diagnosed after being seen by your doctor.

Your doctor will feel and press around your elbow, and ask you to perform movements of your elbow and wrist to find which movements aggravate your pain.

Xray

An X-ray can help your doctor rule out other possible causes of elbow pain, such as arthritis or a fracture

Ultasound and MRI

An Ultrasound and MRI can also help diagnose Tennis Elbow, but is not necessary in every case.

Complications

Chronic pain in the elbow, especially when gripping or lifting objects

Complete tendon rupture – this is a very serious complication requiring surgery. It results in weakness in trying to bend the wrist upwards.

Treatment

Tennis Elbow often gets better on it’s own, without any special treatment. However, it can take up to any from 6 months to a couple of years.

Looking After Yourself

Things you can do for yourself include:

Follow the instructions for R.I.C.E. — protection, rest, ice, compression, elevation

  • Rest. Give your elbow a rest. But don’t avoid all activity. Sometimes, wearing a forearm splint at night helps reduce morning symptoms.
  • Ice. Use a cold pack, ice massage, slush bath or compression sleeve filled with cold water to limit swelling after an injury. Try to apply ice as soon as possible after the injury.
  • Compression. Use an elastic wrap or bandage to compress the injured area.
  • Elevation. Keep your elbow above heart level when possible to help prevent or limit swelling
  • Change Activities. changing the types of activities that are causing or aggravating your pain
  • Medications. use pain killers such as Paracetamol or Anti-inflammatories

Tip: Don’t use Anti-inflammatories for a prolonged period, as they can cause stomach ulcers. 

Rarely, surgery is needed. 

Advice from your Physiotherapist

  • * Analysing the way you use your arm. Have your tennis technique or job tasks to determine the best steps to reduce stress on your injured tissue. This may mean going to a two-handed backhand in tennis or taking ergonomic steps at work to ensure that your wrist and forearm movements don’t continue to contribute to your symptoms. By keeping your wrist rigid during tennis strokes, lifting or weight training, you use the larger muscles in the upper arm, which are better able to handle loading stress.
  • * Exercises. Your physiotherapist may suggest exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm. Once you’ve learned these exercises, you can do them at home or at work.

Advice from your Doctor

If those steps don’t help and you still have pain and limited motion, your doctor may suggest other steps. These may include:

  • * Orthotics. Straps or braces can help to reduce stress on the injured tissue.
  • * Injections. If your pain is severe and persistent, your doctor may suggest an injection of a corticosteroid medication.
    • Corticosteroids are drugs that help to reduce pain, swelling and inflammation. Injectable corticosteroids rarely cause serious side effects. However, these medications don’t provide a clear long-term benefit over physiotherapy exercises or taking a wait-and-see approach and simply resting your arm. 
  • * Surgery. Your doctor will generally recommend surgery only if you have persistent pain and you’ve tried other treatments for longer than six months. Only about 10% of people with tennis elbow need surgery.
    • Surgery involves either trimming the inflamed tendon, or surgically releasing to relieve the pain.
  • Other treatments. There are other forms of treatment for tennis elbow are under investigation. Some treatments being studied include buffered platelet-rich plasma injections, acupuncture, botulinum toxin and topical nitric oxide.

Seeking Advice

Your Family Doctor (GP)

Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to

  • tell you about your problem
  • advise you of the best treatment methods
  • prescribe you medications
  • and if necessary, refer you to Specialists (Consultants) for further treatment

Your Family Doctor (GP)

Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to

  • tell you about your problem
  • advise you of the best treatment methods
  • prescribe you medications
  • and if necessary, refer you to Specialists (Consultants) for further treatment

Your family doctor (GP) will be able to start treating you, offer advice and monitor your progress. You family doctor may refer you to an orthopaedic surgeon if your condition does not improve or you may need an operation.

Be prepared for your appointment

It’s always a good idea to be well prepared for your appointment with your doctor. Here’s some information to help you get ready for your appointment.

Pen and Paper

  • Write down any symptoms you’re experiencing, even any that seem to be unrelated may be important.
  • Make a list of all the medications that you are taking, including any vitamins or supplements
    • also write down the medication details, such as
      • medication name
      • dose
      • how often you take it
      • the reason you take it
  • Write down questions to ask your doctor.
    • These may include:
      • What’s the most likely cause of my problems?
      • Are they any other possible causes?
      • Do I need any special tests or investigations?
      • What treatments are available, and how do they help?
      • Do I need to change or stop my sporting activities, exercises or what I do at work?
      • Are there any fact sheets or printed information that I can take home with me to read?
      • Are there any reliable websites that I can visit?

Prevention

Written by
Physiotherapist 

These steps may help you prevent a tennis elbow injury:

  • Review your technique. Have a tennis professional review your technique to see if you’re using the proper motion. Swing the racket with your whole arm and get your entire body involved in the stroke, not just your wrist. Keep your wrist rigid during ball contact. Also, make sure you have the proper racket grip size and string tension. A lower string tension transmits less force up to the elbow.
  • Build your strength. Prepare for any sport season with appropriate preseason conditioning. Do strengthening exercises with a hand weight by flexing and extending your wrists. Letting the weight down slowly after extending your wrist is one way of building strength so that force is absorbed into your tissue.
  • Keep your wrist straight. During any lifting activity — including weight training — or during tennis strokes, try to keep your wrist straight and rigid. Let the bigger, more powerful muscles of your upper arm do more of the work than your smaller forearm muscles do.
  • Warm up properly. Gently stretch the forearm muscles at your wrist before and after use.
  • Use ice. After heavy use of your arm, apply an ice pack or use ice massage. For ice massage, fill a sturdy paper or plastic foam cup with water and freeze it. Then, roll the ice directly on the outside of your elbow in a circular motion for five to seven minutes.

F.A.Q. | Frequently Asked Questions

What’s the difference between Tennis Elbow and Golfer’s Elbow?

Tennis Elbow occurs on the outside of your elbow, whilst Golfer’s Elbow occurs on the inside.

Medically Tennis Elbow is called Lateral Epicondylitis, whilst Golfer’s Elbow is called Medial Epicondylitis.