Tennis Elbow

Tennis Elbow

Bone, Muscle, & Joint
Sports Medicine
Contributed byKrish Tangella MD, MBAJan 30, 2022

What are the other Names for this Condition? (Also known as/Synonyms)

  • Epitrochlear Bursitis
  • Lateral Epicondylitis
  • Lateral Epicondylitis of Elbow

What is Tennis Elbow? (Definition/Background Information)

  • Tennis Elbow is a painful condition involving the tendons, which attach to forearm muscles on the outside (lateral) part of the elbow. It predominantly occurs, when these tendons, on the outside part of the elbow, are overworked and become inflamed
  • The condition is usually caused by any physical activity, such as an athletic sport, or a normal daily activity that requires repetitive ‘overuse’ of the wrist or arm. Overall, young athletes develop this condition the most
  • Rest, physical therapy, or over-the-counter medications, are usually the initial recommended steps in treating Tennis Elbow. However, surgery is an option, if these aforementioned treatments are unsuccessful

Who gets Tennis Elbow? (Age and Sex Distribution)

  • Tennis Elbow may occur in individuals of all ages, races, ethnic groups, and gender
  • Individuals, between the ages of 40-60 years, have a higher risk
  • Overall, the highest rate of occurrence of the condition is seen among young athletes

What are the Risk Factors for Tennis Elbow? (Predisposing Factors)

Common factors that increase the risk of Tennis Elbow include:

  • Any sport that involves a repetitive overuse of the wrist or arm, such as with tennis or baseball
  • Certain occupations that cause a repetitive stress on the elbow joint, such as with farming, carpentry, or painting

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Tennis Elbow? (Etiology)

Tennis Elbow is caused by muscle strain and repetitive injury, resulting from repeated forearm muscle contractions. The tremendous amount of stress on the elbow tissue can result in chronic episodes of inflammation, building up within the elbow region. Some of the causes associated with Tennis Elbow include:

  • Participating in certain sports activities that involve a set of actions, leading to repetitive overuse of the wrist or arm, such as in baseball or tennis
  • The use of poor throwing techniques (involving lifting the arm over one’s head), while participating in certain sports
  • Certain occupations that cause stress on the elbow joints, due to its repetitive overuse, such as with carpentry or painting
  • Poor fitness level of an individual

What are the Signs and Symptoms of Tennis Elbow?

The signs and symptoms of Tennis Elbow usually develop over time. Most individuals with the condition start to feel some mild pain, as the condition gradually progresses over many months. Signs and symptoms of Tennis Elbow include:

  • Slow progressive pain within the elbow
  • Weakness in the arm, which makes it difficult to grip or hold on to objects
  • Tenderness around the elbow region

How is Tennis Elbow Diagnosed?

Diagnostic methods that a physician may use to help diagnose Tennis Elbow include:

  • Physical examination: A physician will perform a thorough physical examination of the elbow. During this exam, a physician may apply pressure to the affected area and examine the elbow, wrist, and fingers, range of motion. Individuals are also expected to provide an explanation of the circumstances that caused the injury. In addition to this, a complete medical history can aid in arriving at a definitive diagnosis
  • X-ray of the elbow: X-rays use radiation to produce images of the elbow. It can also help the physician rule out other possible causes of elbow discomfort, such as a fracture
  • Magnetic resonance imaging (MRI) of the elbow: An MRI scan is a more detailed scan that uses a magnetic field to produce images that allow a physician to view any damage to the bones and soft tissue that surrounds the elbow joint
  • Electromyography (EMG): An EMG shows the electrical activity of the muscle during rest and during contraction. Examining the electrical activity may help a physician rule out possible nerve compression, which has related sign and symptoms to Tennis Elbow

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Tennis Elbow?

A complication that may occur if Tennis Elbow is left untreated is chronic elbow pain.

How is Tennis Elbow Treated?

A treatment of Tennis Elbow includes the use of both nonsurgical and surgical methods.

  • Any activity that aggravates the elbow condition further should be avoided. The physician may advise the individual to refrain from participating in any physical activities, till the pain or symptoms get better
  • Applying ice to the elbow can help reduce pain and swelling
  • Non-steroidal anti-inflammatory oral medications, such as Ibuprofen and naproxen, can help reduce the pain and swelling, in the elbow
  • Corticosteroid injections help provide temporary relief of symptoms, and in improving the range of motion. It is important to note that corticosteroid injections only give temporary relief. Prolonged episodes of such injections, may injure the joints in the long-run
  • The individual may be advised to wear a forearm strap or brace, to decrease stress on the elbow
  • After the signs and symptoms have abated, it is important to begin some light motion exercises. Physical therapy may help restore strength, as well as improve flexibility, in the muscles
  • Extracorporeal shock wave therapy (ESWT) is an increasingly popular (U.S. FDA-approved) therapeutic approach in which high-energy sound waves are sent to the elbow. However, this therapy is still considered experimental by many physicians; even though research has shown that it may be effective

Surgical treatment:

  • Arthroscopy of elbow joint: Arthroscopic surgery is a minimally-invasive surgical procedure that helps visualize (through a fiber-optic scope connected to a television camera), diagnose, and repair the elbow joint, using small instruments. These instruments are inserted through a small incision within the elbow and guided using a video monitor
  • Open surgery of elbow joint: Open surgery is a surgical procedure in which an incision is made over the elbow, allowing repair of the damaged tissue under direct visualization

How can Tennis Elbow be Prevented?

A daily stretching program can help reduce the chance of the injury recurring for individuals with a history of Tennis Elbow. It is also important to incorporate a strength exercise program, to help strengthen the elbow. Other methods to help prevent Tennis Elbow include:

  • Avoid any physical activity that involves repetitive shoulder movements, for prolonged periods
  • Avoid any repetitive lifting or pulling (especially overhead) of objects that are heavy
  • In sports, learn the correct techniques and avoid poor (overhead) throwing techniques that may cause unstable elbow joints

What is the Prognosis of Tennis Elbow? (Outcomes/Resolutions)

  • The long-term prognosis of Tennis Elbow is usually good in a majority of the individuals
  • Some individuals with severe conditions may experience recurring symptoms, leading to a prolonged recovery
  • When properly treated, a high percentage of individuals regain their full strength and range of motion in their affected elbow

Additional and Relevant Useful Information for Tennis Elbow:

Individuals and professionals, who play tennis, seemed to suffer from Tennis Elbow the most, and hence the term is associated with this sport.

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team


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