Health Centres - Tennis elbow (lateral epicondylitis)
What is tennis elbow?
Tennis elbow is probably caused by an overstraining of the muscles.
The muscles that straighten the fingers and the wrist arise from a small projection of bone on the outer side of the elbow. In the case of tennis elbow, pain is concentrated around this area.
The pain may eventually radiate up the upper arm as well as down the outer side of the forearm.
The pain is caused by tiny breaks in the connective tissue that holds the muscles to the bone. The tissue is irritated and an inflammation sets in, causing swelling in the area. It often heals spontaneously but in a few cases the pain can last for more than five years.
Tennis elbow most frequently affects people in their 40s and upwards, and women are affected more frequently than men.
What causes the condition?
Tennis elbow does not only affect tennis players who of course frequently strain the muscles in this area. It is also caused by other sports and by work or hobbies that involve repetitive movements.
Movements where the elbow is bent while holding tightly onto something such as a racquet or a tool, are the most common causes of tennis elbow.
What does tennis elbow feel like?
Tennis elbow usually starts with gradually increasing pain on the outer side of the elbow. It is painful if someone presses on the area. If you bend the wrist upwards against pressure, it will hurt around the projection of the bone on the outer elbow.
The pains may eventually radiate up into the upper arm and down along the outer side of the forearm. There may be a feeling of weakness in the wrist which makes it difficult to do things that require strength in the hand.
What can be done at home?
At first, the pain may be relieved by applying an ice bag wrapped in a cloth to avoid contact with the skin. The ice bag can be applied for 20 to 30 minutes at a time and again after an interval of about an hour.
The arm should be rested and any movement that causes the pain should be avoided.
Stretching exercises may help. The wrist must be bent all the way down and the hand kept down by the opposite hand. The elbow must be stretched out entirely and the forearm turned inwards so the fingertips point to the side. The stretch should be held for about 15 seconds then repeated after a brief interval. This should be repeated several times a day.
Bandaging and an epicondylitis clasp, which can be bought in many sports shops and pharmacies, sometimes help.
A doctor or physiotherapist can give more information about specific exercises.
How does the doctor make a diagnosis?
Tennis elbow itself cannot be seen on an X-ray. However, in some cases it may be necessary to take an X-ray in order to rule out a possible injury inside the elbow joint.
The doctor checks if the area around the elbow is sore by pressing on it. He also checks if bending the hand upwards against pressure produces pain.
It is important that the doctor rules out the fact that the ailment is not caused by pressure on a nerve. In rare cases there might be other causes for pain in the arm and these have to be ruled out too.
How is the disease treated?
Many cases of tennis elbow will get better by themselves without treatment other than resting the arm and perhaps taking anti-inflammatory medication.
Physiotherapy including ultrasound is often effective.
If symptoms do not settle, a corticosteroid and local anaesthetic injection can be tried.
In resistant cases, it may be necessary to perform an operation to release the tendon from the bone.
Medication
Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain and swelling. There are many types available, including some that can be bought over the counter from a pharmacy, such as ibuprofen
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