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Tennis elbow is soreness or pain on the outer part of the elbow.
- Tennis elbow is caused by damaging the tendons that connect the muscles of your forearm to your elbow
- The pain may spread down your arm to your wrist
- Overuse is the most common cause of tennis elbow
Tennis elbow is generally caused by activities in which you twist your arm over and over. This can stress the tendon, causing tiny tears that in time lead to pain. A direct blow to the outer elbow can also cause tendon damage.
Causes and risk factors
Tennis elbow is common in tennis players, but most people get it from other activities that work the same muscles, such as gardening, painting, or using a screwdriver. It is often the result of using equipment that is the wrong size or using it the wrong way. For example, a tennis racquet with a grip too large for your hand can lead to tendon damage.
Risk factors:
- Activities that involve repeated movements of the forearm, wrist, and fingers. This includes grasping and twisting arm movements done in jobs (such as carpentry, plumbing, or working on an assembly line), daily activities (such as lifting objects or gardening), and sports (such as racquet sports, throwing sports, swimming, or golf).
- Improper techniques while doing certain movements, such as gripping a handle or twisting an object.
- Improper equipment for work, daily activities, and sports, such as using a hammer with a grip that is too large for your hand or a tennis racquet grip that is too large or too small.
- Age. Tennis elbow usually occurs between the ages of 40 and 60 and is most common during the 40s.
- History of tendon injuries.
Symptoms
- Usually occur in the dominant arm (your right arm if you are right-handed, left arm if you are left-handed).
- Affect the outside of the elbow (the side away from your body). Pain increases when that area is pressed or when you are grasping or twisting objects.
- May increase in the evening and make sleep difficult. The elbow might be stiff in the morning.
- Eventually may occur with mild activity, such as picking up a coffee cup; turning a jar lid, doorknob, or key; or shaking hands
Diagnosis and Treatment
Your physician will examine your elbow and ask questions about the elbow problem, your daily activities, and past injuries. You may have an X-ray or one of the following diagnostic procedures:
- Magnetic resonance imaging (MRI) can show problems in soft tissues such as tendons and muscles.
- Arthroscopy allows the health professional to see inside the elbow and get information that can be used together with information from X-rays or a physical exam.
- Bone scans are done in rare cases. They can show stress fractures in the bone or certain disease conditions, such as a tumor or infection.
- Arthrogram (Joint X-ray) is an imaging technology that involves injecting a material into the joint to enhance its X-ray image. It shows the bones and soft tissues inside the joint, such as the cartilage. Since MRI has become more available, arthrography is used less often to enhance X-rays.
- Nerve conduction tests: If your health professional suspects nerve damage, electromyogram and nerve conduction tests can check how well your nerves are working.
Treatment options
The initial treatment for tennis elbow is rest. Resting your fingers, wrist, and forearm muscles will allow your tendon to heal. Stop any activity that you think may be causing your elbow pain and soreness. Depending on the severity of tendon damage, you may have to avoid this activity for weeks to months. Icing your elbow 3 times a day for 10 minutes each time, or according to your health professional's instructions, is also useful.
Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used medicines for treating tennis elbow. NSAIDs are available with or without a prescription.
Your physician may suggest corticosteroid injections if you are still in pain after at least 6 to 8 weeks of tendon rest and rehabilitation.
Surgery
Most cases of tennis elbow are treated without surgery. However, you and your orthopedic specialist might consider surgery if several months of tendon rest and rehabilitation haven't stopped pain or returned the flexibility and strength to your forearm. UCSD Medical Center specializes in minimally invasive procedures, many of which can be performed on an outpatient basis.
Surgery may be indicated if:
- Your elbow is still sore and painful after 6 to 12 months of tendon rest and rehabilitation.
- Your health professional has ruled out other possible causes of elbow pain, such as nerve problems, arthritis, muscle injury, or injury to another tendon.
- Your corticosteroid shots have given good short-term pain relief but the pain has returned.
- You can't do normal daily activities and job tasks because of elbow pain.
During surgery, the orthopedic surgeon will usually cut (release) the tendon, remove damaged tissue from the tendon, or both. In some cases, tendon tears can be repaired. Often, this surgery can be performed arthroscopically, which means less scarring and a faster recovery time.
After surgery, rehabilitation such as physical therapy is necessary to restore flexibility and strength in the forearm.
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