Tennis elbow is an overuse injury of the muscles and tendons in your forearm. Your doctor will diagnose it during a physical exam. They will ask about your job and hobbies and perform some simple tests.
Rest, ice, and pain medicine often help relieve the pain. If these self-care steps don’t help, you might need a treatment like injections or surgery.
Symptoms
The most common symptom is pain and stiffness along the outside of the elbow. This pain often starts slowly and gets worse over time. It can get harder to lift or grip small objects, like a coffee cup. It can hurt more when the arm and hand are extended (straightened).
The muscle involved in tennis elbow is called the extensor carpi radialis brevis. This muscle can be overused by repetitive arm and wrist movements, such as painting; using tools like screwdrivers and hammers; or from long hours of computer use. It can also be overstressed in racquet sports, such as tennis, where the elbow is often bent during a backhand swing. It can also be aggravated by incorrect grip size or poor backhand technique.
Your doctor will make a diagnosis by talking with you and performing a physical exam. They will move your arm, elbow, and wrist in certain ways to see where the pain is. They may also press on the spot where the tendon attaches to the bone. They may order an imaging test, such as a magnetic resonance imaging (MRI) scan or an ultrasound, to check the condition of the tendon. They may also order an electromyography (EMG), which measures the activity of your nerves in your arm. This can help find problems such as a pinched nerve, which causes similar symptoms to tennis elbow.
Treatment for tennis elbow is usually rest and physical therapy. Your doctor may recommend ice to reduce swelling. They may also suggest medications to relieve pain, such as ibuprofen. Your doctor may also inject a corticosteroid medicine into the affected tendon to help decrease inflammation and pain.
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Your doctor will work with you to return to your favorite activities as quickly and safely as possible. They may recommend starting with a shorter activity period and gradually increasing the amount of time you spend on your activity. They will teach you exercises to strengthen the muscles of your forearm and to promote healing. They may also recommend a forearm brace to help spread pressure throughout the arm instead of putting more stress on the injured tendon.
Diagnosis
Symptoms of tennis elbow, also called lateral epicondylitis, are severe pain on the outer side of your elbow that may spread to your forearm and wrist. This condition is caused by repeated stress on the tendons that attach to the outside of your elbow, which can lead to small tears over time. Tennis and other racquet sports, as well as work-related activities that involve repetitive motions of the arm and hand, are most often the cause of this injury.
To diagnose tennis elbow, your healthcare provider will perform a physical exam and ask you about your symptoms. They may gently flex your elbow and wrist and examine the area for swelling and tenderness. They will also ask about your activities and what makes your symptoms better or worse. Your healthcare provider may also order a magnetic resonance imaging (MRI) scan of your arm, which provides detailed images of the soft tissues and muscles, including tendons. An MRI can also help determine if the problem is due to a different type of injury, such as a stress fracture in the elbow bone or a cyst.
Your doctor may also order an electromyography (EMG) test, which measures the electrical activity of your nerves. This can show if the pain is caused by nerve compression in the elbow. Other tests, such as a blood test to see how your body is producing and using vitamin D, may be done to check for other causes of your elbow pain.
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Treatment options for tennis elbow include resting your injured arm and avoiding any activities that make your symptoms worse. Ice therapy, which involves holding a bag of frozen peas or another cold compress against your elbow for 15 to 20 minutes several times a day, can reduce inflammation and improve symptoms. Nonsteroidal anti-inflammatory medications, such as ibuprofen, can also relieve pain. A physical, occupational or hand therapist can teach you exercises to strengthen your forearm muscles and help you learn ways to reduce stress on your injured tissue. Injections of a corticosteroid or platelet-rich plasma can also be used to provide short-term relief. Surgery is rarely needed for tennis elbow, but might be considered if other treatments don’t help after several months.
Treatment
If you’re diagnosed with Tennis Elbow, or lateral epicondylitis, the first step in treatment is rest. You may have to reduce or stop the activities that cause pain for several weeks. This might include racket sports like tennis, but also heavy work activities that require repetitive gripping or lifting. You can use over-the-counter medicines such as ibuprofen and naproxen to ease the pain and swelling. Your doctor can suggest other ways to reduce stress on your tendons, including wearing an elbow splint or brace that helps distribute pressure across the forearm. It’s important to warm up and stretch before playing any sport or exercise that will work your arm and elbow muscles. If you’re having trouble reducing your symptoms, your doctor might recommend physical or occupational therapy. They can teach you exercises to strengthen your forearm muscles and wrist tendons. They can also help you change your work or sports activities so they put less stress on your tendons.
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If nonsurgical treatments don’t improve your symptoms, your doctor might recommend different injections. These can include cortisone, which decreases inflammation and relieves pain for some people. Other options for shots into the injured tendon include trigger point injections and platelet-rich plasma (PRP). Platelet-rich plasma involves taking a sample of your blood and centrifuging it to concentrate the platelets — proteins that encourage healing. Your provider then injects the blood back into the damaged tendon.
Another possible procedure is needle fenestration or ultrasonic tenotomy. These procedures use ultrasound to guide a needle into the injured tendon. They create holes in the damaged tendon to increase blood flow and promote healing.
Surgery is only recommended for severe cases of Tennis Elbow that don’t respond to other treatments. During surgery, your doctor might remove the damaged portion of your tendon. They might also remove scar tissue that’s causing your pain. Then, your doctor will stitch the cut site closed. They might place a splint on your arm to hold it in a stable position while your wound heals. About 80 to 90% of patients who have surgery for Tennis Elbow recover completely.
Prevention
There are a lot of great activities you can do with your elbows, but it’s important to protect them from overuse injuries like tennis elbow (also known as lateral epicondylitis). The outer bony prominence of the elbow (lateral epicondyle) provides the tendon origin for some forearm extensor muscles that lift your fingers and wrist. Repetitive microtrauma or overuse from playing tennis, golf, using hand tools, carpentry work, painting, and even typing on a keyboard can cause this injury to develop.
Most cases of Tennis Elbow are due to overtaxing these muscles and tendons. Avoiding overtaxing these muscles may not be possible for some, but avoiding doing things that make symptoms worse can.
If you play a racquet sport, consider getting a professional to teach you proper technique. This will help reduce stress on the forearm muscles and tendons, preventing pain and overuse. We can also recommend stretching and strengthening exercises to improve grip and forearm strength. These include wrist flexion with resistance bands, forearm extensions, and dumbbell grip exercises.
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For non-athletes, we can also recommend ergonomic changes at work or home to prevent repetitive motion injuries. We can refer you to an occupational therapist who specializes in teaching proper body mechanics to reduce elbow stress and injury.
In some cases, we can offer steroid injections to decrease inflammation and increase pain relief. We can also refer you to a physical therapist who can offer manual therapy and other treatments such as cryotherapy or platelet-rich plasma injections to decrease inflammation and speed up recovery time.
If you have been diagnosed with Tennis Elbow, or have been experiencing symptoms of this condition, contact one of our offices online or by phone to set up an appointment. We can help you recover from Tennis Elbow and return to the activities you love! We look forward to hearing from you.
