Tennis elbow, or lateral epicondylitis, is a common condition that affects the tendons and muscles that attach to the outer part of the elbow. It is caused by overuse or repetitive stress on the wrist and arm, especially during activities that involve gripping, twisting, or extending the wrist, such as playing tennis, golf, or using tools. Tennis elbow can cause pain, stiffness, and weakness in the elbow, forearm, and wrist, and can interfere with daily activities and quality of life.
What Causes Tennis Elbow?
Tennis elbow is a type of tendinopathy, which means inflammation or degeneration of the tendons. Tendons are tough, fibrous tissues that connect muscles to bones. The tendons that are affected by tennis elbow are called the extensor carpi radialis brevis (ECRB) and the extensor digitorum communis (EDC). These tendons originate from the lateral epicondyle, a bony bump on the outside of the elbow, and extend to the back of the hand and fingers. These tendons help to straighten and stabilize the wrist and fingers.
Tennis elbow occurs when these tendons are subjected to excessive or repetitive stress, which can cause micro-tears, inflammation, and scarring in the tendon tissue. This can result in pain, stiffness, and weakness in the elbow, forearm, and wrist. The pain can also radiate to the upper arm and shoulder.
The most common cause of tennis elbow is overuse or repetitive stress on the wrist and arm, especially during activities that involve gripping, twisting, or extending the wrist, such as playing tennis, golf, or other racket sports, using tools, typing, or lifting heavy objects. These activities can put too much strain on the tendons, especially if they are done with poor technique, inadequate equipment, or insufficient warm-up or rest.
Other possible causes of tennis elbow include:
- Injury or trauma to the elbow, such as a direct blow, a fall, or a sudden twist
- Age-related degeneration of the tendons, which makes them more prone to damage and less able to heal.
- Medical conditions that affect the tendons, such as arthritis, diabetes, thyroid disorders, or gout
- Genetic factors that influence the structure and function of the tendons.
Tennis Elbow Symptoms
The main symptom of tennis elbow is pain and tenderness in the outer part of the elbow, where the tendons attach to the bone. The pain can also spread to the forearm and wrist, and can vary in intensity and frequency. Some people may experience mild or occasional pain, while others may have severe or constant pain. The pain can be triggered or worsened by
- Moving the wrist or fingers, especially when gripping, twisting, or extending the wrist.
- Lifting or carrying objects, especially with the palm facing down.
- Shaking hands or squeezing objects.
- Opening a door or a jar.
- Holding a phone or a cup.
Other tennis elbow symptoms may include:
- Stiffness and reduced range of motion in the elbow, forearm, and wrist.
- Weakness and difficulty in performing tasks that require fine motor skills, such as writing, buttoning, or using a keyboard or a mouse.
- Swelling and inflammation in the elbow, forearm, and wrist.
- Numbness and tingling in the hand and fingers.
How Is Tennis Elbow Diagnosed?
To diagnose tennis elbow, a doctor will ask about the symptoms, medical history, and activities that may cause or aggravate the pain. The doctor will also examine the elbow, forearm, and wrist, and look for signs of tenderness, swelling, and weakness. The doctor may also perform some tests to check the function and sensation of the wrist and fingers, and to rule out other possible causes of elbow pain, such as arthritis, nerve compression, or fracture.
Some of the tests that the doctor may use to diagnose tennis elbow include:
- Cozen's test: The doctor will ask the patient to make a fist, bend the wrist, and extend the elbow, while the doctor presses on the lateral epicondyle. If this causes pain, it indicates tennis elbow.
- Mill's test: The doctor will ask the patient to straighten the arm and bend the wrist, while the doctor presses on the lateral epicondyle. If this causes pain, it indicates tennis elbow.
- Chair test: The doctor will ask the patient to lift a chair with the palm facing down, while the doctor holds the chair. If this causes pain, it indicates tennis elbow
The doctor may also order some imaging tests, such as X-rays, ultrasound, or MRI, to confirm the diagnosis, assess the severity of the damage, and rule out other conditions that may affect the elbow, such as bone spurs, arthritis, or tumors.
Tennis Elbow Treatment
The treatment for tennis elbow depends on the severity of the condition, the patient's preferences, and the doctor's recommendations. The main goals of tennis elbow treatment are to relieve pain, reduce inflammation, promote healing, restore function, and prevent recurrence. The treatment options for tennis elbow include conservative treatment and surgical treatment.
Conservative treatment
Conservative treatment is the first line of treatment for most cases of tennis elbow, and it involves non-surgical methods, such as:
- Rest: The patient should avoid or limit activities that cause or worsen the pain, and allow the tendons to heal. The patient may also use a splint, brace, or bandage to immobilize and support the elbow, forearm, and wrist.
- Ice: The patient should apply ice or a cold pack to the affected area for 15 to 20 minutes every four to six hours for the first few days, to reduce pain and inflammation. The patient should wrap the ice or cold pack in a towel or cloth, and avoid direct contact with the skin.
- Medication: The patient may take over-the-counter or prescription pain relievers, such as ibuprofen, naproxen, aspirin, or acetaminophen, to reduce pain and inflammation. The patient should follow the dosage and instructions on the label, and consult the doctor if the pain persists or worsens. The patient should also be aware of the possible side effects and interactions of these medications, such as stomach ulcers, bleeding, liver damage, and kidney problems.
- Physical therapy: The patient may see a physical therapist, who can design a customized exercise program to strengthen and stretch the muscles and tendons of the elbow, forearm, and wrist, and improve the mobility and flexibility of the joint. The physical therapist may also use other modalities, such as massage, ultrasound, electrical stimulation, or shock wave therapy, to enhance the healing process and reduce pain and inflammation.
- Injections: The doctor may inject corticosteroids, platelet-rich plasma, or botulinum toxin into the affected area, to reduce pain and inflammation, and stimulate healing. These injections are usually reserved for cases that do not respond to conservative treatment, and they may have some risks and complications, such as infection, nerve damage, or tendon rupture.
Surgical treatment
Surgical treatment is the last resort for cases of tennis elbow that do not improve after six to 12 months of conservative treatment, or that cause severe pain and disability. The surgery involves removing the damaged part of the tendon, and repairing the remaining tendon to the bone. The surgery can be done through an open incision, or through a minimally invasive technique, such as arthroscopy. The surgery can relieve pain and restore function, but it may also have some risks and complications, such as infection, bleeding, nerve damage, or loss of motion. The surgery requires general or regional anesthesia, and a hospital stay of one or two days. The recovery time may vary from six weeks to six months, depending on the type of surgery, the patient's condition, and the rehabilitation program.
How to Prevent Tennis Elbow from Happening or Recurring?
The best way to prevent tennis elbow from happening or recurring is to avoid or modify the activities that cause or aggravate the condition, and to take care of your elbow, forearm, and wrist. Some of the preventive measures that you can take are:
- Warm up and stretch before and after your activities, especially those that involve repetitive or excessive wrist and arm movements. This can help you prepare your muscles and tendons for the activity, and prevent stiffness, pain, and injury.
- Use proper equipment and technique for your activities, such as ergonomic keyboards, mice, pens, rackets, and grips. They should be lightweight, comfortable, and fit your hand size and shape. You should also use a softer grip, a lower string tension, and a larger racket head for racket sports, to reduce the impact and vibration on your elbow.
- Take frequent breaks and rest your elbow, forearm, and wrist during your activities. You should also alternate your hands and change your position or posture every 15 to 20 minutes. This can help you avoid overuse and fatigue of your muscles and tendons, and prevent strain and injury.
- Wear a brace, splint, or bandage to support and stabilize your elbow, forearm, and wrist during your activities. This can help you reduce the stress and strain on your tendons, and prevent inflammation and pain.
- Strengthen and stretch your elbow, forearm, and wrist muscles and tendons regularly, with the help of a physical therapist or a doctor. This can help you improve your mobility and flexibility, and prevent stiffness, pain, and inflammation. It can also help you prevent muscle atrophy and weakness, and improve your function and strength.
Frequently Asked Questions About Tennis Elbow
Here are some frequently asked questions about tennis elbow, and their answers:
Can a tennis elbow heal on its own?
Tennis elbow can heal on its own, without any treatment, in some cases. However, this may take a long time, from six months to two years, and the pain and disability may persist or recur. Therefore, it is advisable to seek medical attention and treatment for tennis elbow, as this can help you heal faster and prevent further damage and complications.
Can tennis elbow affect both arms?
Tennis elbow can affect both arms, but it is more common to affect one arm, usually the dominant one. However, some people may develop tennis elbow in both arms, especially if they do activities that involve repetitive or excessive wrist and arm movements with both hands, such as playing tennis, golf, or using tools.
Can tennis elbow cause numbness in the hand and fingers?
Tennis elbow can cause numbness in the hand and fingers, in some cases. This can happen if the inflammation or swelling of the tendons compresses the radial nerve, which runs along the forearm and elbow, and supplies sensation and movement to the hand and fingers. This can result in a condition called radial tunnel syndrome, which can cause numbness, tingling, and weakness in the hand and fingers, especially the thumb, index, and middle fingers.
How can I tell the difference between tennis elbow and golfer's elbow?
Tennis elbow and golfer's elbow are similar conditions that affect the tendons and muscles of the forearm and elbow, but they differ in the location and direction of the pain. Tennis elbow affects the tendons that attach to the outer part of the elbow, and causes pain when extending the wrist and fingers. Golfer's elbow affects the tendons that attach to the inner part of the elbow, and causes pain when flexing the wrist and fingers.
Tennis elbow is a common and painful condition that affects the tendons and muscles that attach to the outer part of the elbow. It is caused by overuse or repetitive stress on the wrist and arm, especially during activities that involve gripping, twisting, or extending the wrist, such as playing tennis, golf, or using tools. Tennis elbow can cause pain, stiffness, and weakness in the elbow, forearm, and wrist, and can interfere with daily activities and quality of life.
Tennis elbow can be treated with rest, ice, pain relievers, physical therapy, injections, or surgery, depending on the severity of the condition, the patient's preferences, and the doctor's recommendations. The main goals of treatment are to relieve pain, reduce inflammation, promote healing, restore function, and prevent recurrence.
One of the most effective methods to prevent or manage tennis elbow is to wear a tennis elbow brace, such as the Tennis Elbow Brace With Compression Pad from Zofore Sport. This brace can provide support, compression, and pain relief to the affected area, and help you recover faster and prevent further injury. You can also prevent tennis elbow by modifying your activities, improving your posture and technique, and doing some exercises and stretches.
References
- American Academy of Orthopaedic Surgeons (AAOS) “Tennis Elbow (Lateral Epicondylitis)”
- WebMD “Tennis Elbow (Lateral Epicondylitis)”
- American Society for Surgery of the Hand (ASSH) “Tennis Elbow - Lateral Epicondylitis”
- National Institutes of Health (NIH) “Lateral Epicondylitis (Tennis Elbow)”
- MedlinePlus “Tennis elbow”
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