Tennis elbow, also sometimes referred to as lateral epicondylitis, is a condition involving pain in the area of the elbow that is usually associated with overuse of the area. In particular, the muscles and tendons in the forearm become damaged due to repeated movements, which causes the discomfort.
Although anyone can suffer from Tennis Elbow, the name of the condition is named due to the high incidence of the condition among people that play tennis and other racquet sports.
The primary cause of tennis elbow is overuse of the forearm muscles that help to stabilize the wrist when the arm is extended, which often occurs in sports that are involved with a racquet. With continued use over time, small tears appear in the tendon, which lead to the symptoms pain.
There are many groups of people who are at risk of getting Tennis Elbow in addition to those that play sport frequently, including:
It is worth noting that these vocations are all associated with repetitive movements of the arms. Tennis Elbow is most common in individuals aged between 30 and 50 years, which is likely due to this age group partaking in more activities that put an individual at risk of Tennis Elbow.
In most cases, the signs and symptoms develop slowly, beginning as a mild pain that gradually gets worse over time. Eventually, pain on the lateral side of the elbow becomes significant and patients may also have weak grip strength.
Although both sides can be affected, often the dominant arm is affected to a greater extent, likely due to the increased use of the arm.
The symptoms commonly worsen when the forearm is actively used. Continuing to use the arm in sport or at work is not recommended because the symptoms are less likely to improve.
There are several factors that should be considered when making a diagnosis of Tennis Elbow. These include:
- Symptoms of pain on the lateral side of the elbow.
- Activities believed to cause the condition (e.g. sport, occupation)
- Triggers for worsening of symptoms
- History of elbow injuries, arthritis or nerve diseases
A physical examination is also often required, particularly to view the point at which the pain is most noticeable, usually when the arm is fully extended. In some cases, specialized imaging techniques such as X-ray, magnetic resonance imaging (MRI) and electromyography (EMG) may be required to eliminate other conditions with similar symptoms.
Most patients with Tennis Elbow notice a significant improvement in symptoms upon ceasing causative activities and allowing the muscle and tendons to rest. It is important that patients understand the value of resting and discontinuing sport or occupational activities whilst the area heals. Using ice to cool the area can also help to reduce the pain and swelling.
For the immediate management of pain, non-steroids anti-inflammatory drugs (NSAIDS) such as aspirin or ibuprofen can offer effective relief. Paracetamol may also help, but NSAIDs have the added benefit of reducing inflammation that may be causing symptoms to worsen. For a stronger anti-inflammatory effect, steroid injections with cortisone may be beneficial
There are also some specific exercises that are indicated in the management of Tennis Elbow, which help to strengthen the muscles in the forearm that are affected. A brace to support the area may also be recommended in some circumstances.
For unresponsive patients, surgery to replace the diseased muscle with healthy muscle may be recommended. Open surgery is the most common technique, which involves an incision over the elbow to access the muscle. Alternatively, arthroscopic surgery involves smaller instruments and several small incisions.
Following surgery, patients require rehabilitation with exercises to stretch the new muscle and restore flexibility. After approximately 8 weeks exercises to strengthen the muscle are introduced and patients typically return to normal athletic activity within 4-6 months.