Tennis elbow or lateral epicondylitis (also known as “hooter’s elbow” and “archer’s elbow“) is a medical condition in which the outer part of the elbow becomes aching and tender. It is commonly connected with playing tennis and other sports involving racquet, though the injury can occur to almost anybody.
Any repetitive movement of the wrist, including tennis, hedge clipping, too much use of a hammer or screwdriver, painting, or any activity that involves constant gripping or squeezing can develop the condition known as tennis elbow. In the game of tennis, the following drills can cause tennis elbow:
- One-handed backhand with poor body language
- A late forehand swing making the wrist bend considerably
- Snapping and turning the wrist while serving with full force
- Pain on the outer part of elbow known as lateral epicondyle.
- Softness over the lateral epicondyle
- Gripping and actions of the wrist hurt, especially wrist extension and lifting actions.
- Activities that involve the muscles to extend the wrist such as, pouring a pitcher or gallon of milk, lifting with the palm down are characteristically painful.
- Morning stiffness.
- Pain and tenderness in the forearm.
- Pain typically lasting for 6 to 12 weeks. The discomfort can persist for as little as 3 weeks or as long as several years.
Exams and Tests
The diagnosis is carried out by both discrete and characteristic medical signs and symptoms. One can feel point tenderness over the origin of the extensor carpi radialis brevis muscle from the lateral epicondyle (ECRB origin). There should also be pain accompanied with passive wrist flexion and also with resisted wrist extension (Cozen’s test), both tested with the elbow extended.
An easy at-home test can be done to find out whether you have tennis elbow:
Stand behind a chair, place your hands on top of the chair back with your palms down, and try to pick up the chair. If this gives you pain on the outside of your elbow, you are most likely to have tennis elbow.
X-ray images may be necessary if the symptoms imply another problem in the elbow joint.
Nerve studies may be done in order to find out entrapment of the radial nerve in the elbow joint (this is termed as radial tunnel syndrome) if your symptoms persist in spite of effective treatment.
It is unlikely your doctor will feel the need to ask you for blood tests, a CT scan, or an MRI to make the diagnosis easier.
Local heat may encourage healing. Alternate hot and cold application may augment the blood flow to the part and eliminate substances resulting in the pain. Local massage may also help in raising the blood flow and reducing the swelling. Wearing long sleeves may give momentary relief from pain by keeping the elbow area warm and promoting rest. Drugs such as ibuprofen may be taken to lessen swelling and pain. A pain-relieving ointment containing diclofenac may be prescribed by the physician in order to alleviate pain and promote healing.
During the severe stage of your injury, whether the medial or lateral elbow is affected, follow the RICE principle as stated below:
Rest – this suggests avoiding further overuse but not lack of activity. You should keep up as high an activity level as possible while avoiding activities that intensify the injury. Complete rest should not be taken as it encourages muscle atrophy, deconditions tissue, and reduces blood supply to the area, all of which interferes with the healing process. Pain best suggests how to find out the suitable type and level of activity.
Ice – it is recommended as long as inflammation persists; that is, throughout the entire rehabilitation method and come back to sports. Ice reduces the inflammatory process decelerates local metabolism and helps soothe pain and muscle contraction.
Compress and elevate if apt to assist venous return and reduce swelling.
It is the most significant part of the treatment including diverse modalities for preventing and treating tennis elbow. Gentle stretching exercises such as wrist flexion, extension and rotation are useful. The elbow should be extended and not flexed in order to increase the amount of stretch as needed. These stretches are instructed to hold for 20-30 seconds and repeated 5-10 times, at least twice a day. Vigorous stretching should not be followed – do not stretch to the point of pain because it may reproduce your symptoms.
Anti-inflammatory medications are often suggested in order to manage pain and inflammation. The oral forms of these medications are easy to consume and often help control inflammation and reduce pain.
If these conservative measures do not succeed, a steroid (cortisone) injection may be recommended. If a person has taken more than 2 cortisone injections without giving break, it is unlikely that the patient will be benefited by additional injections.
An elbow orthosis, also called an elbow clasp, can be put on because the brace will redirect the pull of misaligned muscles. Patients often find relief from pain while using the clasp during activities.
There are several possible surgical treatments that have been successful. These include removing a portion of the damaged tendon or releasing the attachment of the affected tendon. A repair of the healthy portion of tendon is sometimes carried out as well. In addition, arthroscopic elbow surgery has become an option for some patients with tennis elbow.
Candidates for surgery are usually those who have had symptoms for more than 6-12 months despite nonsurgical therapies.
Several months of rehabilitation at home in working with a physical therapist are required and begin about 6 weeks after surgery.
As with any surgery, there are risks, which you should talk about with your doctor.
For tennis players:
Adjust racquet size: Use a midsized racquet. The popular oversized racquets can put too much strain on the arm and increase the risk of injury.
Loosen string tension: Higher string tension can increase the torque and vibration the arm experiences, thereby increasing the risk of injury.
Adjust grip size: A grip too small or too large decreases your control of the racquet and increases your risk of injury.
Check racquet material: Graphite racquets and nylon strings seem to decrease the torque and vibration the arm receives, thus reducing the risk of injury.
Overall: Ease into any repetitive motion activity around the house and at work and rest at the first sign of pain or soreness.
Continue exercises for strength and flexibility even after your pain has gone away before engaging in tennis or other repetitive motion activities.
Lift objects with your palm facing your body.
Try strengthening exercises with hand weights. With your elbow cocked and your palm down, repeatedly bend your wrist. Stop if you feel any pain.
Stretch relevant muscles before beginning a possibly stressful activity by grasping the top part of your fingers and gently but firmly pulling them back toward your body. Keep your arm fully extended and your palm facing outward.
Discontinue or modify the action that is causing the strain on your elbow joint. If you must continue, be sure to warm up for 10 minutes or more before any activity involving your arm, and apply ice to it afterward. Take more frequent breaks.
Try strapping a band around your forearm just below your elbow. If the support seems to help you lift objects such as heavy books, then continue with it. Be aware that such bands can cut off circulation and impede healing, so they are best used once tennis elbow has disappeared.