What is Tennis Elbow?

Tennis Elbow (2)

Tennis elbow is one of the most common strain injuries, but surprisingly not well understood. This is partially because of differences in definition and labelling.  Here are some of the various terms often called tennis elbow:  Tennis elbow; extensor carpi radialis tendonitis; lateral epicondylitis; radialis tendonitis, elbow tendinosis.  Perhaps the general term, Lateral Elbow Tendinopathy would be most appropriate.

SIGNS AND SYMPTOMS

Tennis elbow may result in the following:Tennis Elbow

  • Pain with touch, tenderness, swelling at or near the lateral epicondyle (see diagram)
  • Aching, burning that radiates into your forearm
  • Limited ability to grip and/or bend your wrist up or down due to pain
  • Weakness with gripping
  • Pain with extending your 1st or 2nd fingers against resistance

CAUSES

In most cases, this is related to repetitive or overuse injuries to the group of forearm and hand muscles that attached to the lateral side of your elbow.  This is more often related to specific occupations that overload these muscle groups.  However in a substantial proportion of cases, the cause is unknown.

Yes, tennis players actually get tennis elbow (about 50% of amateur players).

DIAGNOSIS

The diagnosis of tennis elbow is typically determined by a qualified health professional through a clinical exam.  An ultrasound may have some benefit to identify tendon thickening or tearing, and an X-ray can show bony changes (calcifications or bony extosis).

Currently, we only classify something as tennis elbow when all of the following are true:

  • Pain with pressure on the outside of your elbow at the common extensor origin of the wrist (see the diagram)
  • Pain with resisting the extension movement of your wrist
  • Decreased grip strength

Care must be taken to rule out nerve pathology originating from the cervical spine.  Clinically we often find a portion or all of the symptoms of lateral elbow pain is resolved by addressing and treating the patient’s neck.

TREATMENT

  • Physiotherapy which may include manual therapy, acupuncture, a home exercise program, taping/bracing, and modalities (e.g. icing regimen).  Most importantly, your therapist should help you identify and modify the factors that have initially caused the problem and are sustaining it.
  • Anti-inflammatories usually only help if there is active inflammation present.  In most cases there is not.
  • Difficult cases may be referred for corticosteroid injections or orthopaedic surgery (which generally involves removal of the tissue identified as pathological).

PROGNOSIS

Without treatment, most cases do self-resolve within a year.

However chronic cases (> 1year), or those where there is nerve entrapment or a tendon tear involved, have poorer outcomes.

The good news is that the latest research shows that simple physiotherapy is more effective in the long run than the 2 other most common treatments (wait and see, and corticosteroid injections).

FINAL WORD

Tennis elbow can be confusing and difficult to diagnose, therefore harder to treat.  If left unaddressed, it can also have some long-term or permanent consequences.  Have an expert assess your condition so you’ll get better faster.