Lateral epicondylitis (tennis elbow) is a painful condition involving the
tendons that attach to the bone on the outside (lateral) part of the elbow.
Tendons
anchor the muscle to bone. The muscle involved in this condition, the extensor
carpi radialis brevis, helps to extend and stabilize the wrist.
With lateral
epicondylitis, there is degeneration of the tendon’s attachment, weakening the
anchor site and placing greater stress on the area. This can then lead to pain
associated with activities in which this muscle is active, such as lifting,
gripping, and/or grasping. Sports such as tennis are commonly associated with
this, but the problem can occur with many different types of activities,
athletic and otherwise.
Cause
Tennis elbow
is caused by repeated use of the forearm muscles that extend your wrist and
fingers. The repeated stress to the tissue may cause tiny tears in the tendons
that attach to the outside of the elbow.
Any activity
repeatedly done with palms facing downward can cause tennis elbow. These
activities include:
• Repetitive
tasks such as typing, using tools etc.
• Prolonged
gripping tasks such as riding a motorcycle or a bicycle, pushing or carrying heavy
loads.
Trauma – A direct blow to the elbow may
result in swelling of the tendon that can lead to degeneration. A sudden
extreme action, force, or activity could also injure the tendon.
Who gets it?
The most
common age group that this condition affects is between 30 to 50 years old, but
it may occur in younger and older age groups, and in both men and women.
Signs and Symptoms
Pain is the
primary reason for patients to seek medical evaluation. The pain is located
over the outside aspect of the elbow, over the bone region known as the lateral
epicondyle. This area becomes tender to touch. Pain is also produced by any
activity which places stress on the tendon, such as gripping or lifting. With
activity, the pain usually starts at the elbow and may travel down the forearm
to the hand. Occasionally, any motion of the elbow can be painful. Tennis
elbow pain can appear slowly or suddenly. Symptoms can include:
Treatment
Home care:
You may try
these methods to care for tennis elbow:
Activity modification
and rest– Initially, the activity causing the condition should
be limited. Limiting the aggravating activity, not total rest, is recommended.
Medication
– anti-inflammatory
medications may help alleviate the pain.
Brace – a tennis
elbow brace, a band worn over the muscle of the forearm, just below the elbow,
can reduce the tension on the tendon and allow it to heal.
Taping — Tape your elbow to help provide
support to the soft tissues. Seek the help of a physical or occupational
therapist to show you how to tape your elbow.
Ice application— using ice several times daily can
relieve pain.
– Ice pack
application. Place a towel between your skin and the ice pack. Leave the ice
pack on the painful area for 10-15 minutes. Check your skin every five minutes
to ensure you are not injuring your skin.
– Ice
massage. Using an ice pack, massage directly on the outside of your elbow in a
circular motion for about 5 minutes.
– Manual
massage. Massage may help increase blood flow, reduce sensitivity and relieve
pain. Ask a physical or occupational therapist to show you how to perform massage.
Exercises
Stretching
and strengthening can be effective treatments for tennis elbow. The goal of
exercising is to strengthen the muscles to prevent pain and promote a healthy
recovery.
Forearm
extensor stretch
1. Hold the
affected arm out in front of you with the elbow slightly bent.
2. Curl the
fingers of your affected arm and place your other hand over the knuckles.
Gently pull the hand and wrist of the affected arm inward until you feel a
slight stretch along your arm. You should feel some tension along your arm, but
do not pull so hard that your arm hurts.
Eccentric
wrist extensor strengthening
1. Rest your
affected arm on a table, allowing your hand to hang freely over the edge.
2. Use the
other hand to lift the hand of the affected arm until the hand is raised. Hold
the hand in this position while you release the helping hand.
3. Slowly
allow the hand of your affected arm to lower back to the position of hanging
freely. This slow movement is called a “controlled release” or an “eccentric
muscle contraction.”
Isometric
wrist extensor strengthening
1. Rest your
affected arm on a flat surface holding your wrist out straight over the edge.
2. Use the
other hand to apply a downward pressure on the hand of the affected arm while
keeping the wrist out straight.
Isotonic
wrist extensor strengthening
1. Rest your
affected arm palm down on a table or your lap allowing your hand to hang over
the edge.
2. Bend your
wrist to raise your hand up, then down.
Other
treatments for tennis elbow include electrical stimulation, iontophoresis and ultrasound.
Depending on the severity and duration of your symptoms, you may benefit from
these treatments. Your physician and therapist can identify the best methods to
help you manage your condition.
Steroid
injections – A steroid is a strong anti-inflammatory medication that
can be injected into the area. No more than 2-3 injections should be given.
Please consult your physician to discuss this option.
Surgery
Surgery is
only considered when the pain is incapacitating and has not responded to
conservative care, and symptoms have lasted more than six months. Surgery
involves removing the diseased, degenerated tendon tissue. Arthroscopic (key
hole surgery) and traditional open surgical techniques are utilized to treat
tennis elbow.
The Hand Surgery Clinics blog provides information of a general nature about the specialty of Hand and Upper Extremity Surgery. The information is provided with the understanding that Hand Surgery Clinics is not engaged in rendering hand surgery medical advice or recommendations. Any information on the blog should not be considered a substitute for consultation with a qualified hand surgeon to address individual medical needs. Your particular facts and circumstances will determine the hand surgery treatment which is most appropriate for you.