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Lateral Epicondylitis

(Tennis Elbow)

Definition

Lateral epicondylitis is pain at the elbow. The pain occurs over the bone on the outside of the elbow. There are several muscles and tendons that attach on this area of the bone.

This condition is often called tennis elbow, but it is not restricted to people who play tennis. It can also occur in people with jobs that require repetitive motions such as roofers and carpenters.

Lateral Epicondylitis

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Causes    TOP

Lateral epicondylitis is caused by damage to a tendon.

Tendons connects muscles to bone. Repetitive or stressful movements of the muscles causes strain and pain at the tendon. The tendons associated with lateral epicondylitis are connected to forearm muscles. These muscles are active when you grip something, such as a tennis racquet. Actions that can cause irritation to the tendons of the elbow include:

  • Improper technique for hitting a tennis ball
  • Improper size of tennis racquet or tension of racquet strings
  • Improper golf swing technique or grip of golf clubs
  • Doing certain arm motions too much, such as:
    • Tennis strokes
    • Golf swings
    • Painting
    • Raking
    • Pitching
    • Rowing
    • Using a hammer or screwdriver

Risk Factors    TOP

Factors that increase your risk of lateral epicondylitis include:

  • Playing tennis or golf
  • Work that requires repetitive wrist extension and gripping with a closed fist
  • Muscle imbalance
  • Decreased flexibility
  • Increased age

Symptoms    TOP

Lateral epicondylitis may develop slowly over time. It may not be associated with a sudden injury. Symptoms include:

  • Pain and tenderness on the outside of the elbow
  • Possibly pain extending down the forearm
  • Tightness of forearm muscles
  • Stiffness or trouble moving the elbow or wrist
  • Lack of full elbow extension

Pain may be most noticeable when doing activities like:

  • Shaking hands
  • Turning doorknobs
  • Picking up objects with your palm down
  • Hitting a backhand in tennis
  • Swinging a golf club
  • Pressing on the outside of the elbow

Diagnosis    TOP

You will be asked about your symptoms and medical history. You may also be asked about your recent physical activity.

The doctor will examine your elbow for:

  • Pain on the outside of the elbow when:
    • Doing certain arm motions
    • Pressure is applied on the outside of the elbow
  • Stiffness of elbow and wrist movement

X-rays are not usually necessary. However, an x-ray may be needed if the doctor suspects other problems.

Treatment    TOP

Treatment includes:

Rest

Activities that cause pain will need to be avoided. Sports and repetitive motions will need to be stopped until the pain is gone. Activities will need to be altered:

  • When lifting objects, lift with your palms up
  • Consult a sports professional to check your form when playing tennis or golf

Ice

Regular ice application may help decrease some discomfort and swelling.

Physical Therapy    TOP

You may be referred to a physical therapist. You will learn exercises that may help reduce your symptoms and maintain strength.

Medication    TOP

Medications may be advised to reduce swelling and pain:

  • Nonsteroid anti-inflammatory drugs (NSAIDs)
  • Acetaminophen
  • Topical pain relievers that are applied to the skin

Compression    TOP

Certain injuries may require a brace. It is placed on your forearm. This brace limits the force of your forearm muscles on the tendon.

Cortisone Injection    TOP

The doctor may inject cortisone into the tendon. This may help to reduce pain and inflammation in the short term. Unfortunately, the injection may not help in the long run.

Returning to Physical Activity     TOP

  • Heat may be helpful when returning to physical activity. It can decrease the stiffness in the muscle or tendon.
  • Start gentle stretching of the wrist and elbow as advised. Do not push the stretch to the point of pain.
  • Maintain strengthening exercises for the forearm muscles.
  • Gradually return to the sport. Talk to a sports professional to adjust technique, if needed.

Prevention    TOP

To help reduce your chance of lateral epicondylitis:

  • Keep your arm muscles strong. This will decrease the stress on the tendons.
  • After a short warm-up period, stretch out your arm muscles.
  • Learn the proper technique for activities that require forearm motion.
  • If you play tennis, ask a tennis specialist to check your:
    • Technique for hitting the ball, especially your backhand
    • Racket size, tension of racket strings, and composition of the racquet frame

RESOURCES:

Ortho Info— American Academy of Orthopaedic Surgeons
http://orthoinfo.org
Sports Med—American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org/Patient

CANADIAN RESOURCES:

Canadian Association of General Surgeons
http://www.cags-accg.ca
Canadian Orthopaedic Foundation
http://www.canorth.org

References:

Chumbley EM, O'Connor FG. Evaluation of overuse elbow injuries. Am Fam Physician. 2000;61(3):691-700.
Nirschl RP, Kraushaar BS. Keeping tennis elbow at arm's length. Phys Sportsmed. 1996.
Nirschl RP, Kraushaur BS. Assessment and treatment guidelines for elbow injuries. Phys Sportsmed. 1996;24.
Tennis elbow (lateral epicondylitis). Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis. Updated July 2015. Accessed November 15, 2017.
11/8/2006 DynaMed Plus Systematic Literature Surveillance http://www.dynamed... : Bisset L, Beller E, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial. BMJ. 2006;333:939.
10/26/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com: Massey T, Derry S, et al. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.
Last reviewed November 2017 by EBSCO Medical Review Board Teresa Briedwell, PT, DPT, OCS, CSCS
Last Updated: 12/20/2014

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