Tennis Elbow (Epicondylitis)

Overview

Tennis elbow, also known as epicondylitis, is a type of tendonitis that affects the elbow and arm. Generally, tennis elbow develops from overusing the same forearm muscles and tendons repeatedly. When this occurs, you may feel pain or tenderness in your elbow or arm.

Tennis elbow is the most common elbow injury. It is most common in people around 40 years old.

In mild cases, self-care therapies such as rest, ice, and anti-inflammatory medications alone can relieve symptoms associated with tennis elbow.

Tennis elbow causes

Tennis elbow develops over time from repetitive motions that strain the muscles and stresses the tendons.

Activities that may cause tennis elbow include:

• Weight lifting
• Squash
• Tennis
• Baseball
• Racquetball

Tennis elbow symptoms

Symptoms of tennis elbow include:

• Pain on the outside of the elbow.
• Limited ability to grip objects.

Symptoms gradually develop over time. In most cases, there is not a specific injury that is associated with the onset.

Tennis elbow complications

If tennis elbow is left untreated or not treated appropriately, complications can develop, including:

• Recurrence of injury
• Ruptured tendons - typically from overuse of steroid injections
• Nerve entrapment that limits the ability to improve

Tennis elbow risk factors

Risk factors associated with tennis elbow include:

• Tennis elbow most commonly affects people between the ages of 30 and 50.
• Anyone who has a job that requires repetitive wrist or arm movements such as a carpenter, chef or painter, is at higher risk of developing tennis elbow.
• Participating in certain sports. Participating in sports such as tennis or racquetball can increase your risk of developing tennis elbow.

Tennis elbow prevention

Tennis elbow can be prevented by avoiding putting a strain on the elbow tendons and prevent disease progression. Other ways to prevent progression include:

• When playing a sport that requires repetitive wrist or elbow movements, work with a technique specialist to help improve your technique.
• Build arm strength before playing a sport that requires repetitive arm movements.
• Wear an elbow splint when using your arm.

Tennis elbow diagnosis

Your doctor can diagnose tennis elbow during a clinic visit. Your doctor will review your symptoms and perform a physical exam. During the physical exam, your doctor will move your elbow, wrist, and fingers in a variety of motions and apply pressure to the area where you have the most pain.

You may not need a diagnostic imaging test to diagnose tennis elbow, but when your doctor suspects a more severe cause of your symptoms, you may need an X-ray or another imaging test.

Tennis elbow treatment

In many cases, tennis elbow will heal on its own with over-the-counter pain medication, rest, ice, and self-care. If conservative measures are not working alone, your doctor may recommend physical therapy, a forearm brace, or in the most severe cases, surgery.

• Physical Therapy — Your doctor can teach you strengthening and stretching exercises to help build the forearm muscles.
• Injections such as Botox or platelet-rich plasma (PRP) that are injected directly into the affected area may help relieve pain associated with tennis elbow.
• Ultrasonic tenotomy. This nonsurgical procedure works by using ultrasonic energy in the damaged tendon. During the procedure, the damaged tissue will liquefy and be sucked out of the body.
• After six to 12 months of conservative treatment for tennis elbow, surgery may be necessary to remove damaged tissue. Your doctor will outline different surgical options and recommend the one most appropriate for your case. The procedure may be performed through a series of small incisions (minimally invasively) or one large incision. Physical therapy after surgery is required to get your arm functioning back at the same level before the injury.

When to Seek Care

If you have rested, iced, and used pain medications for a few weeks, and your symptoms are not improving or worsening, schedule an appointment with your doctor.

Next Steps

Before your appointment, take notes about your symptoms, when they started occurring and when they are most severe.  Also, note any questions you have for your doctor.

If you are diagnosed with tennis elbow, follow your doctor’s treatment and recovery instructions carefully.

When your injury heals, you can return to your normal activity, but gradually increase your level of participation. If you experience any pain, stop.

It could take as long as 12 months to feel normal again after treatment.