Lateral epicondylitis is pain over the bone on the outside of the elbow. The piece of bone that can be felt on the outside of the elbow is called the lateral epicondyle. When the tendons attached to this bone are overused, they can deteriorate and become inflamed and painful.

Lateral epicondylitis is commonly called tennis elbow, but it is not restricted to people who play tennis. It occurs in people who do manual labor with their hands, such as roofers and carpenters.

Causes

Tennis elbow is caused by overusing the forearm extensor muscles. These muscles extend the wrist and are active when you grip something, such as a tennis racquet. Overusing these muscles can cause deterioration or tearing of the tendons attached to the lateral epicondyle.

Causes include:

• Improper technique for hitting a tennis ball

• Improper size of tennis racquet or tension of racquet strings

• Doing certain arm motions too much, such as:

• • Tennis strokes

• • Golf swings

• • Painting

• • Raking

• • Pitching

• • Rowing

• • Using a hammer or screwdriver

• Improper golf swing technique or grip of golf clubs

• Wrong model of golf clubs

Risk Factors

A risk factor is something that increases your chance of getting a disease, condition, or injury.

• Playing tennis or golf

• Work that requires repetitive wrist extension and gripping with a closed fist

• Muscle imbalance

• Decreased flexibility

• Advancing age

Symptoms

Symptoms include:

• Pain and tenderness on the outside of the elbow

• Pain increases when:

• • Shaking hands

• • Turning doorknobs

• • Picking up objects with your palm down

• • Hitting a backhand in tennis

• • Swinging a golf club

• • Pressing on the outside of the elbow

• Possibly pain extending down the forearm

• Tightness of forearm muscles

• Stiffness or trouble moving the elbow or wrist

• Lack of full elbow extension

Diagnosis

The doctor will ask about your symptoms and medical history, your recent physical activity, and how the injury occurred. You may not remember the event that caused the injury because tennis elbow pain develops over time. The doctor will examine your elbow for:

• Pain on the outside of the elbow when:

• • Doing certain arm motions

• • Pressing on the lateral epicondyle

• Stiffness of elbow and wrist movement

X-rays are not usually necessary. However, the doctor may x-ray your elbow to make sure the bones of the elbow are normal, and that there is no calcium deposit in the tendon attachments.

Treatment

Treatment includes:

Rest–Do not do activities that cause pain. Do not play sports, especially tennis, until the pain is gone.

Ice–Apply ice or a cold pack to the outside of the elbow for 15-20 minutes, four times a day for several days. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.

Medication–Take one of the following drugs to help reduce inflammation and pain:

• Aspirin

• Ibuprofen (Motrin, Advil)

• Naproxen (Aleve, Naprosyn)

• Acetaminophen (Tylenol)

If you still have tenderness in the elbow while taking these drugs, do not return to physical activity. Check with your doctor.

Compression–Wear a counter-force brace on your forearm if recommended by your healthcare professional. This brace limits the force generated by your forearm muscles when you use them.

Heat–Apply heat to the elbow only when you are returning to physical activity. Then use it before stretching or getting ready to play sports.

Stretching–When the acute pain is gone, start gentle stretching of the wrist and elbow as recommended by a healthcare professional. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times.

Strengthening–Begin strengthening exercises for your wrist extensor muscles as recommended by a healthcare professional.

Gradual Return to Your Sport–Begin arm motions of your sport or activity as recommended by a healthcare professional. (For example: tennis strokes, golf swings, painting)

Cortisone Injection–The doctor may inject cortisone into the tendon attachment at the lateral epicondyle to reduce pain and inflammation.

According to a recent study involving 198 adults suffering from tennis elbow for at least weeks, eight sessions of physical therapy combining elbow manipulation with prescribed exercises improved symptoms in the short-term more than a wait-and-see approach. In the same study, corticosteroid injections were helpful in the first six weeks, but no better than physical therapy after the first six weeks and associated with recurrences later on. After one year, none of the three approaches were superior. *

Prevention

To reduce your risk of getting tennis elbow:

• Keep your arm muscles strong so they can absorb the energy of sudden physical stress.

• After a short warm-up period, stretch out your arm muscles.

• Learn the proper technique for activities that require forearm motion.

• If you play tennis, ask a tennis specialist to check your:

• • Technique for hitting the ball, especially your backhand

• • Racket size, tension of racket strings, and composition of the racquet frame

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org

The American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

References:

American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org.

The American Orthopaedic Society for Sports Medicine website. Available at: http://www.sportsmed.org.

Assessment and treatment guidelines for elbow injuries. Phys Sportsmed. 1996 May.

Human Tendons. Human Kinetics; 1997.

Keeping tennis elbow at arm's length. Phys Sportsmed. 1996 May.

Nicholas Institute of Sports Medicine and Athletic Trauma website. Available at: http://www.nismat.org/.

Updated section on Treatment on 11/8/06 according to the following study, as cited by DynaMed's Systematic Literature Surveillance: Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006 Nov 4;333(7575):939.