Definition

Tennis elbow (lateral epicondylitis) is one of several overuse injuries that can affect your elbow. As you might guess, playing tennis is one cause of tennis elbow — but many other common activities can cause tennis elbow, too.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to the bony prominence on the outside of your elbow (lateral epicondyle). Pain can also spread into your forearm and wrist.

Tennis elbow is similar to golfer’s elbow. But golfer’s elbow occurs on the inside — rather than on the outside — of your elbow.

The pain of tennis elbow doesn’t have to keep you from enjoying your favorite activities. Rest and over-the-counter pain relievers often help. Rarely, surgery is an option.

Causes    

Tennis elbow is an overuse injury. It’s caused by repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in inflammation or a series of tiny tears in the tendons that attach the forearm muscles to the bone at the outside of your elbow.

As the name tennis elbow indicates, playing tennis — particularly, repeated use of the backhand stroke with poor technique — is one possible cause of the condition. However, many other common arm motions can cause tennis elbow, too — including using a screwdriver, hammering, painting, raking, weaving and others.

Symptoms

Signs and symptoms of tennis elbow may include:

    * Pain that radiates from the outside of your elbow into your forearm and wrist
    * Pain when you touch or bump the outside of your elbow
    * Pain when you extend your wrist
    * A weak grip
    * A painful grip during certain activities, such as shaking hands or turning a doorknob

The pain often gets worse over weeks or months. Sometimes you may feel pain even when your arm is still.

Treatments and drugs

Initial treatment of tennis elbow usually involves self-care steps including rest, icing the area and use of acetaminophen (Tylenol, others) or over-the-counter anti-inflammatory medications, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others). These medications aren’t recommended for long-term use because they can cause serious gastrointestinal problems.

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

    * Analyzing the way you use your arm. Your doctor may suggest that experts evaluate 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 doctor or a physical therapist 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. Your doctor may also suggest you wear straps or braces to reduce stress on the injured tissue.
    * Corticosteroids. 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 physical therapy exercises or taking a wait-and-see approach and simply resting your arm. Your doctor may also suggest use of topical corticosteroids for pain relief. These corticosteroids are absorbed through your skin during a treatment called phonophoresis.
    *

      Surgery. If other approaches haven’t relieved your pain and you’ve been faithful to your rehabilitation program, your doctor may suggest surgery. Your doctor will generally recommend surgery only if your arm movement is still restricted and you’ve tried other treatments for about a year. Only about one in 10 people with tennis elbow needs surgery.

      You’ll be able to have the surgery done on an outpatient basis, meaning you can go home the same day. Surgery involves either trimming the inflamed tendon, or surgically releasing and then reattaching the tendon to relieve pain.

Other treatments for tennis elbow are under investigation. Some treatments being studied include low-energy shock wave treatment, acupuncture, botulinum toxin, orthotic devices, such as braces or straps, and treatment with topical nitric oxide.

Prevention

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. Lower string tension of around 55 pounds 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 for five to seven minutes.

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