TENNIS ELBOW (LATERAL EPICONDYLITIS)

CONDITION

Tennis elbow occurs when the tendons that attach forearm muscles to the bony projection on the outside of the elbow (the lateral epicondyle) break down, become inflamed or are torn. These tendons and muscles (Figure 1 below) allow you to bend your wrist back or up, as you do when you hold a tennis racket, pick up a jug of milk or open a door.

Figure 1

Causes

Overuse, repetitive motion, a single lifting event or a direct blow to the tendon attachment can cause this injury. Other risk factors include:

being over 30 years old
using poor sports technique, such as making frequent off-center hits in racquet sports
using a racquet with strings that are too tight or with a handle that is the wrong size
abruptly becoming a lot more active.

Symptoms and Signs

You will have aching and, sometimes, sharp pain over the outside of the elbow.
The pain can sometimes go down the outside of the upper forearm.
Pain is worse during and shortly after activities that cause the problem.
You may feel pain when you open a door, pick up a coffee cup, type, shake hands, garden or use a hammer or other tools.
There may be swelling over the outside of the elbow.
If you have weakness and numbness or problems feeling your forearm or hand, you may have a pinched nerve instead of tennis elbow.
If you have a lot of swelling and pain on the outside of your elbow and if you can’t bend or straighten your elbow completely, especially after a fall on an outstretched hand, you may have an elbow fracture.

WHEN TO CALL YOUR DOCTOR

Call your doctor right away (day or night) if:

You have severe pain, swelling and/or numbness over your elbow and forearm after a fall or injury.
You can’t fully straighten or bend your arm after a fall or injury.

Call your doctor during regular office hours if:

You have mild to moderate pain after a fall or injury, but don’t have problems feeling your forearm or hand and can bend and straighten your elbow completely.
You have had pain and swelling that have been getting worse over time.

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SELF-CARE AT HOME

Rest your arm and hand from activities that cause pain.
- Avoid bending the wrist backward or up if it hurts.
- Avoid picking up objects that are heavy enough to cause pain.
- Take a break from racquet sports until your symptoms are minimal or go away, which usually takes from one to four weeks.
For swelling and pain control, apply a cold pack or an ice pack to your elbow three times a day for 20 minutes at a time. Hold the pack in place with plastic wrap or an elastic wrap. You may do this for up to 20 minutes every hour if you need to. If you use an ice pack, consider placing a washcloth between the pack and your skin to avoid frostbite.
- Ice massage can help. Freeze water in a paper cup, peel the top of the cup back so the ice is sticking out, then rub the ice over the painful area for three to five minutes at a time. Let your elbow get warm between massages.
- You can use ice massage anytime you are having pain or after arm activities that will probably cause pain.
You may take ibuprofen (Advil® or Motrin®) if you can tolerate it. (See the labels for dose and risks.)
Braces or straps, particularly the kind with a built-in air pad http://www.aircast.com/index.asp/fuseaction/patient.main), can help decrease pain and increase function.

Wrap a tennis elbow strap snugly over your forearm, with the air pad positioned right in front of where the tendons attach to your elbow.
If you still have a lot of pain after trying the tennis elbow strap, wear a wrist splint (Figure 2 below) that holds your hand in a neutral position to rest your forearm tendons.

Figure 2

Most drug stores and some convenience stores stock braces and straps.

You may start doing certain stretching and strengthening exercises before you see your doctor:
- Straighten your arm out fully and push down the back of your hand (Figure 3 below) so that you feel a stretch across the top of your forearm. Hold the stretch for 30 seconds, rest briefly and repeat three times. Do this exercise once or twice a day.
- Hold a light weight (a soup can works well) in your hand, palm facing down. Bend your hand upward at the wrist so that it is pulled back (Figure 4 below). Hold this position for two seconds and then lower your hand slowly. Repeat this 10 to 20 times, rest a minute and do it again. Do this exercise at least once daily.
- A hammer works well for this next exercise, which also involves using a light weight, or you may use a can. With your palm down, hold the hammer by the handle so that the hammer head is facing in the direction of your thumb. If you are using a can, wrap your hand around it. Slowly turn your hand and wrist palm up, then slowly return it to a palm-down position (Figure 5 below). Repeat this 10 to 20 times, rest a minute and do it again. Do this exercise at least once daily.
You can massage your injured tendons a few times daily. Using two fingers, apply firm pressure with a back-and-forth rubbing motion for two to three minutes. This may stimulate healing.
If you have severe pain, problems bending your arm or numbness in your forearm or elbow, do not do any exercises or use any braces. Put your arm in a sling and see your doctor.

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FOR MORE INFORMATION

American Academy of Family Physicians: Hand, Wrist and Arm Problems

REFERENCES

Melhoff T, Bennet J: Elbow Injuries. In Mellion M, Walsh M, Madden C, et al: Team Physician’s Handbook, 3rd edition, Hanley & Belfus, Philadelpia, 418-426, 2002.
Sellards R: The Elbow: Diagnosis and treatment of Common Injuries. Primary Care 32(1):1-16, 2005.
Whaley AL: Lateral Epicondylitis. Clinics in Sports Medicine 23(4):677-91, 2004.

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Authored by Christopher Madden, M.D.

Favorably reviewed by The American Medical Society for Sports Medicine

http://amssm.org

Disclaimer: This content is reviewed periodically and is subject to change as new healthcare information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.