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St. Mary's Center for Orthopaedics

Tennis Elbow (Lateral Epicondylitits)

What is Tennis Elbow?

Lateral epicondylitis is pain at the elbow. The pain occurs over the bone on the outside of the elbow. There are several muscles and tendons that attach on this area of the bone. Tendons are strong fibers that attach muscles to bone. They are tissues that do not stretch easily and are susceptible to degeneration under repeated or traumatic stress. This condition is often called tennis elbow, but it is not restricted to people who play tennis. It can also occur in people with jobs that require repetitive motions such as roofers and carpenters.

What Causes Tennis Elbow?

Tennis elbow is caused by damage to a tendon.  Tendons connect muscles to bone. Repetitive or stressful movements of the muscles cause strain and pain at the tendon. The tendons associated with lateral epicondylitis are connected to forearm muscles. These muscles are active when you grip something, such as a tennis racquet. Actions that can cause irritation to the tendons of the elbow include:

  • Improper technique for hitting a tennis ball
  • Improper size of tennis racquet or tension of racquet strings
  • Improper golf swing technique or grip of golf clubs
  • Doing certain arm motions too much, such as:
  • Tennis strokes
  • Golf swings
  • Painting
  • Raking
  • Pitching
  • Rowing
  • Using a hammer or screwdriver

What are the Symptoms of Tennis Elbow?

Tennis elbow may develop slowly over time. It may not be associated with a sudden injury. Symptoms include:

  • Pain and tenderness on the outside of the elbow
  • Possibly pain extending down the forearm
  • Tightness of forearm muscles
  • Stiffness or trouble moving the elbow or wrist
  • Lack of full elbow extension

Pain may be most noticeable when doing activities like:

  • Shaking hands
  • Turning doorknobs
  • Picking up objects with your palm down
  • Hitting a backhand in tennis
  • Swinging a golf club
  • Pressing on the outside of the elbow

How is Tennis Elbow Diagnosed?

A physician will perform an examination and review the individual’s medical and activity history to make a diagnosis of Tennis Elbow. The physician evaluates the forearm structures by using simple tests. The history and examination, supplemented with X-rays of the elbow are sufficient to make the diagnosis. X-rays may be used to assess if the elbow bone was injured and help rule out other possible causes of elbow pain, such as arthritis. Magnetic Resonance Imaging (MRI) scans are rarely used to diagnose Tennis Elbow however MRI scans may be used to provide a very detailed view of the tendon injury.

What are the Treatments for Tennis Elbow?

Non-Surgical
Most cases of Tennis Elbow respond to non-surgical treatments. Treatment typically includes:

  • Rest or activity restriction/alteration.
  • Specific exercises, often under the guidance of a therapist, are often prescribed.
  • Physicians may instruct the application of ice to the affected areas or recommend medication to relieve pain.
  • Wrist splints and forearm bands can be used to relieve symptoms and promote healing.
  • Corticosteroid medications (Corticosteroid medication is a relatively safe pain reliever and in the case of tennis elbow would be injected at the outside of the elbow.)

After the pain is relieved, physical or occupational therapy may be needed. The physical or occupational therapists focus on improving physical functioning for participation in activities. The therapies address muscle strength, flexibility, endurance, and coordination.

Surgery
The majority of individuals with Tennis Elbow do not require surgery. Surgery is considered if significant pain continues after at least six months of treatment. The surgery is performed as an outpatient procedure. The individual may remain alert with regional anesthesia or be sedated for the surgery. The surgeon makes a small opening at outside of the elbow bone and then removes any injured tissue and reattaches the tendon to the bone. Recently, an arthroscopic surgery method has been developed. Arthroscopic surgery uses a small camera, called an arthroscope, to guide the surgery. Only small incisions need to be made and the joint does not have to be opened up fully. This technique can provide a positive outcome and a shortened recovery time.

Following surgery, the elbow is placed in a small splint. After about one week, the individual can begin physical or occupational therapy to stretch the elbow joint and increase motion. Muscle strengthening can begin at about two months after the surgery. Individuals typically return to full activity levels four to six months after surgery. Tennis Elbow surgery produces successful outcomes for the vast majority of individuals.

What are Recovery Expectations for Tennis Elbow?

With non-surgical treatments, symptoms of Tennis Elbow may be relieved as early as four to six weeks. However, many individuals have chronic symptoms for many months. Individuals requiring corticosteroid injections or surgery may take several months to recover, but typically can achieve good results. Tennis Elbow does not usually lead to severe problems if it is treated. If left untreated, it rarely leads to loss of motion and function.