Tennis Elbow

Orthopaedics & Joint Replacement | Posted on 01/19/2022 by Dr. Aashish K. Sharma

Tennis elbow, medically known as lateral epicondylitis, is a form of tendinitis that affects the tendons of the elbow area. These tendons connect the forearm muscles to the bone. It is a painful condition resulting from the weakening of the tendons due to repetitive arm movement, especially in the elbow area. Tennis elbow accounts for only 5% of cases and usually requires only minor treatment.

Symptoms of tennis elbow

A patient with a tennis elbow may experience shooting pain in the bony knob located on the outside of the elbow. This bony knob connects the wounded tendons to the bone. The pain, though concentrated on the bony knob, may even extend to the upper or lower arm. The patient is likely to suffer excruciating pain while performing tasks with their hands. This could include –

• Lifting objects, especially any heavy object
• Making a fist or gripping objects like a tennis racket that requires making a fist
• Opening a door, particularly doors with a cylindrical or ball knob that needs to be turned to open
• Holding a coffee mug
• Shaking hands
• Raising hands
• Straightening the wrist

When to see a doctor

If you find no relief from self-care methods, especially the R.I.C.E method, which stands for Rest, Ice Pack, Compression, and Elevation, and even over-the-counter pain relievers have had no effect, it may be a good time to visit a doctor.

Causes of Tennis Elbow

Notwithstanding its name, you can get tennis elbow even if you haven’t been near a tennis court in your life, let alone played a game in it. This is because there are several other causes responsible for this type of tendinitis besides repetitive tennis play. The condition seldom occurs abruptly, but gradually develops over time. Repetitive motions and constant tugging lead to microscopic tears in the tissue.

The causes behind tennis elbow include –

• Grabbing a swing
• Fencing
• Weightlifting
• Repetitive use of computer mouse
• Playing games like racquetball and squash
• Jobs that involve repetitive arm movements or require constant gripping – raking, knitting, carpentry, typing, plumbing, and painting, cutting up cooking ingredients, especially meat

Risk factors

Certain factors may increase the risk of developing the condition. These factors include –

• Age – Though tennis elbow can affect people of all age groups, it is most commonly observed in adults between the ages of 30 and 50.
• Occupation – People involved in occupations that demand constant movement of their arms are at a higher risk of developing tennis elbow. This includes plumbers, carpenters, painters, butchers, and typists, among others.
• Certain sports – Of all sports, racket sports like tennis and badminton make one more susceptible to the condition. The risk is higher among those who frequently employ the poor stroke technique.

Diagnosis and treatment

To diagnose a person with tennis elbow, a doctor will generally ask for the patient’s medical history and symptoms. Then, the patient might be asked to do some simple arm movements such as straightening the wrist and folding the arm to check for any pain while doing so. In some cases, the doctor might opt for imaging tests like X-ray and MRI scans to take a better look at what’s going on inside the arm.

Post-diagnosis, the patient will be asked to stop playing sports or do certain kinds of work like typing, painting, etc. to give the arm proper rest. However, since “absolute rest leads to rust,” the patient may need to learn the use of the shoulder and upper arm muscles so that there is some movement but no strain on the elbow. The doctor may recommend the following treatment options based on the severity of the condition –

• Physical therapy or physiotherapy – This is perhaps the first resort and is generally an effective one. Treatments may include exercises or stretches guided by the therapist, massage, heat, and cold therapy, ultrasound to ease muscle pain and increase blood flow, etc.
• Use of splint or braces – Such tools is beneficial in relaxing the wounded tendons and muscles. 
• Corticosteroid medications – These will be injected into the injured or affected area to reduce swelling and pain.
• Orthopedic surgery – In extreme cases, the damaged tendon will have to be removed through surgery. This surgery can be performed in two ways – open surgery where the surgeon makes a cut above the bone on the side of the elbow, removes the damaged tendon, and reattaches the healthy part of the bone, or arthroscopic surgery wherein a few tiny cuts are made into the skin over the elbow, small instruments and a camera are inserted through these holes which guide the surgeon in removing the damaged parts of the tendon.

Post-treatment, the condition should become better within a few short weeks; however, it may take longer for those with surgical removal of the damaged tendon. During this period, it is recommended to abstain from sports and constant arm movements, take plenty of rest, and use an ice pack for 15 minutes three times a day to speed up the healing process.