What is tennis elbow?

Tennis elbow, also known as lateral epicondylitis, is the persistent pain in the outer side of the elbow. In comparison, Golfer's elbow is the pain on the inside of the elbow.

Tennis elbow is caused by a repetitive injury to a tendon in the elbow, from an overuse of the forearm muscles attached to the tendon. This type of injury can be caused not just by playing tennis but also by other sports or some work-related movements. 

Tendon

Dense bands of connective tissue that attach muscles to bones.

Causes

Tennis elbow is a type of overuse injury that affects the tendon attached to the extensor muscles in the forearm. The extensor muscles help pull the hand back and aid turning the arm so that the palms face upwards. The tendon for the extensor muscles of the forearm is attached to the outer side of the elbow joint. Repeated overuse of the extensor muscles can cause minor injuries to the tendon (known as tendinopathy). If these injuries are not adequately healed by the body, the tendon damage can accumulate and lead to persistent inflammation and pain.

Tennis elbow.Tennis elbow is a result of accumulated tendon damage in the forearm. 

Tendon

Dense bands of connective tissue that attach muscles to bones.

Risk factors

Risk factors for tennis elbow include:

  • Overuse of the forearm muscles;
  • Age - most people who experience tennis elbow are 30 to 50 years of age;
  • Incorrect repetitive movements while playing sports such as tennis or golf, and;
  • Work or any activity that requires repetitive use of the forearm muscle, such as painting, plumbing, carpentry or even using a computer mouse.

Signs and symptoms

Signs and symptoms of tennis elbow include:

  • Pain in the outer side of the elbow that radiates to the forearm;
  • The pain is worse when moving the wrist back or turning the forearm so that the palm is facing upwards; 
  • Weakness in the forearm;
  • Gradual onset of pain, and;
  • Difficulty performing activities that require arm strength.

Methods for diagnosis

Your doctor will diagnose tennis elbow after performing a physical exam and asking you questions about your pain and activities. Rarely, additional tests such as X-rays or ultrasound may be needed to exclude other causes and/or assess the severity of tendon damage.  

Tendon

Dense bands of connective tissue that attach muscles to bones.

Types of treatment

There are numerous treatment options for tennis elbow. Initially, rest and heat or ice packs may provide relief. Other treatments include:

Arm brace

A strap used to apply pressure to the muscles in the forearm can reduce pressure on the injured tendon. Arm braces can be used during sport or work. Wrist splints, which prevent full forearm movement, are not a substitute for arm braces and should be avoided.

Exercises

Exercises to improve muscle flexibility can improve arm strength and mobility.

Flexibility exercises

While sitting or standing upright, you can hold your arm outstretched and point your fingers down to the ground. Then hold the hand of your injured arm with your other hand, and pull back on it to stretch the forearm muscles. This stretch may be held for 30 seconds, repeated three times and performed daily.

Flexibility exercise for tennis elbow.A flexibility exercise. 

Strengthening exercises

A special type of exercise, called eccentric strengthening, can be used once flexibility has improved and no pain is felt when performing them. This exercise involves the use of a weight or elastic band to provide resistance.

To perform this exercise, lie down on a bed. Rest your out-stretched arms on the bed, with your hands hanging over the edge of the bed and the palms facing the floor. From this starting position, use a half-kilogram weight in your hand, then gradually bend your wrist back, then return it to the starting position. This is ideally performed ten times, which is known as a 'set', then repeated for another two sets, with a one-minute rest in between. It is generally advised that these exercises be done every day and the weight increased when the exercise can be done without pain.

Pain-relief medication

Pain-relief medications, such as acetaminophen or ibuprofen, can help manage the pain. If the pain is ongoing, your doctor may suggest injections of corticosteroid anti-inflammatory medication, around the injured tendon.

Surgery

Surgery is used as a last resort, when other treatment options have failed to alleviate pain after several months. Surgery can include dividing the tendon, removing the damaged area of the tendon and/or repairing the tendon.

Tendon

Dense bands of connective tissue that attach muscles to bones.

Potential complications

Aside from pain, the major complication of tennis elbow is that it impedes your ability to perform physical activities, such as certain sports or types of work.

Prognosis

You may experience pain for several weeks during certain sports or work-related activities. Most people respond to treatment, but some will require rehabilitation with a physiotherapist.

Prevention

To help prevent tennis elbow:

  • Remember to take frequent breaks from repetitive movements and to stretch after activity;
  • Avoid lifting objects with your arms fully stretched out;
  • Use wrist supports during weight training;
  • Use mouse pads to support your wrist when using a computer mouse;
  • Hold heavy tools with both hands, and;
  • Ensure you use the correct sports technique. Sometimes this requires consulting a physiotherapist or sports physiologist. In tennis, for example, adapt a two-handed backhand grip when playing, engaging your lower body, hip and back, rather than just using your elbow. Little things, such as the size of your racket grip, as well as the type and tension of the strings, can contribute to problems in the elbow. Using softer strings with less tension and the heaviest racket that does not affect your swing may help.