FAQS on Lateral Epicondylitis or Tennis Elbow
Lateral epicondylitis, commonly called tennis elbow, causes pain in the elbow traced to overworked tendons. Not confined only to those playing tennis, the condition affects about a third of workers, such as carpenters, plumber, and others, who repetitively use their hands to accomplish tasks. About 10% of lateral elbow pain instances require surgical procedure while 90% heal with non-operative treatments.
What is tennis elbow or lateral epicondylitis?
Lateral epicondylitis or tennis elbow is a condition characterized by pain just above the elbow on the lateral or outer side of the upper arm bone. It indicates presence of an inflammation due to injury to the tendons at the elbow joint. Thus, the problem is a form of tendinopathy of the elbow.
The disorder was first mentioned as medical condition in 1873. A decade later, it was officially mentioned as “lawn-tennis elbow” by Henry Morris in a research published in the Lancet journal (1882). But disagreement over the pathology in the subsequent years resulted in the naming of the disorder as lateral elbow tendinopathy, angio-fibroblastic tendinosis, epicondyle pain, tennis arm, etc. The name lateral epicondylitis came into being as the primary region affected by the pain outer side of your elbow bone area called the lateral epicondyle.
The name tennis elbow is widely used because the injury is often similar to “tears in the forearm tendon attachment at the elbow caused by the repetitive nature of hitting thousands of tennis balls.” Also 10 to 40% of tennis players suffer from the problem mostly traced to “strain injury to this forearm tendon from hitting a backhand shot at tennis.”
What are the symptoms of tennis elbow or lateral epicondylitis? When to see a doctor?
- Pain in the outer side of the elbow joint
- Worsening pain over time
- Elbow tenderness
- Pain radiating to forearm and back hand
- Feeble grip strength
- Pain worsens with forearm activity or lift something
How does tennis elbow or lateral epicondylitis occur?
Tennis elbow pain starts at the lateral epicondyle area as you bend your wrist or make a grip. There are three bones – humerus or the upper arm, radius, and ulna – in the elbow joint. Lateral epicondyle refers the bony bump on the outer side of your elbow. A single tendon connects forearm muscles stretched up to the wrist and fingers with the lateral bump.
As the wrist and fingers bend or grip, the forearm muscles make contraction and expansion movements. This causes the connecting tendon to pull and push the joint bones to move them so that you can hit a tennis ball or grip something.
Often the tendons are overloaded or subject to sudden impacts due to strong and forceful forearm muscle movements. This leads to fraying injuries or tears in the tendon, which in turn set the stage for inflammation and formation of scar tissue causing damage to the tendon and it aggravates with further activities. Patients with such elbow injuries are diagnosed with lateral epicondylitis or tennis elbow.
What causes tennis elbow or lateral epicondylitis?
- Forearm tendon overuse or injury
- Overuse or forearm muscle strain causing inflammation
- Injury causing tear in the extensor carpi radialis brevis or forearm muscle
- Gradual wear and tear with age
- Recurring, forceful use of forearm muscle
- Racquet sports, constant computer keyboard use
- Trauma due to direct blow to the epicondyle
- Hammering, weight lifting frequently
- Improper use of backhand
- Frail shoulder, wrist muscles
What are the risk factors?
Tennis elbow mostly affects people above 40 years or those involved in sports or occupational activities with the risk of repetitive use of forearm muscles. Painters, carpenters, tennis players, cooks, those typing regularly, weight lifter, chain saw operators, autoworkers, construction workers, and plumbers are at the increased risk.
How is tennis elbow or lateral epicondylitis diagnosed?
Physical examination of symptoms is the foremost factor in making a diagnosis. Patients’ occupational history, ability to move the wrist, participation in activities, including sports, and onset of the condition help establish the condition.
X-ray, MRI, and electromyography are useful in ruling out potential arthritis, neck and shoulder disorders, herniated disk problem, or nerve compression leading to the elbow pain.
What are the treatment methods available for tennis elbow or lateral epicondylitis?
- Nonsurgical Treatment
Almost 90% cases of tennis elbow are successfully treated with one of the following or a combination of following methods.
- Rest and self-care: Give your arm proper rest and avoid activities that worsen the pain.
- Medications: Anti-inflammatory medicines inhibit inflammation and aid in healing of the tendon.
- Equipment check: Use improved equipment during sports, such as smaller, looser-strung racquets, and other activities to minimize pressure on the injured muscles.
- Physical therapy: Mild to moderate wrist stretching and strengthening exercises help the muscles and tendons remain flexible and have enhanced resistance ability. Apply ice massage, soft tissue massage, and muscle-stimulating techniques to quicken the healing.
- Brace: It provides ample rest to the forearm muscles and tendons.
- Extracorporeal shock wave therapy: Sound waves initiate microtrauma in the muscles and promotes natural healing of the muscle. Research studies indicate 50% success with the therapy mostly used prior to surgery.
- Steroid injections: Cortisone steroid relieves inflammation and other symptoms on semi-permanent basis.
- Surgical Treatment
It involves removal and repair of the damaged part of the tendon and reattachment of strong muscles with the bone. Whether it is tendon release or tendon debridement, both open and arthroscopic options are available depending on the extent of injury and surgical requirements.
The latest revolution in treating degenerative and traumatic ligament and muscle injuries, it activates formation of new tissues that replace the damaged ones through regenerative stem cells or platelet rich plasma injections. A number prolotherapy studies carried on in the last decade highlight up to 93% success rate in providing relief to those with tennis elbow.
J GREG, et al. Treatment of Lateral Epicondylitis. Am Fam Physician. 2007 Sep 15;76(6):843-848.
T J Alan. THE EARLY HISTORY OF TENNIS ELBOW: 1873 TO THE 1950s. Australian and New Zealand Journal of Surgery
Volume 68, Issue 3, pages 219–224, March 1998
M Scarpone, et al. The efficacy of prolotherapy for lateral epicondylosis: A pilot study. Clin J Sport Med. 2008 May; 18(3): 248–254.
M Allan, et al. Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma. The American Journal of Sports Medicine, Vol. X, No. X, May 30, 2006
Nirschl RP (October 1992). “Elbow tendinosis/tennis elbow”. Clin Sports Med 11 (4): 851–70.
Reynolds, Gretchen, “Phys Ed:An Easy Fix for Tennis Elbow?”, The New York Times, August 25, 2009
Pattanittum, P; Turner, T; Green, S; Buchbinder, R (May 31, 2013). “Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults.
Krogh, TP, et al. “Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials.”. The American journal of sports medicine 41 (6): 1435–46
Roetert EP, Brody H, Dillman CJ, Groppel JL, Schultheis JM. The biomechanics of tennis elbow. An integrated approach. Clin Sports Med. Jan 1995;14(1):47-57.