Tennis elbow

Answer 1

Definition

Tennis elbow is an inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow. There may be a partial tear of the tendon fibers, which connect muscle to bone, at or near their point of origin on the outside of the elbow.

Alternative Names

Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral

Causes, incidence, and risk factors

This injury is due to repeated motions of the wrist or forearm. The injury is typically associated with tennis playing, hence the name "tennis elbow." However, any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to this condition.

Symptoms

• Elbow pain that gradually worsens
• Pain radiating from the outside of the elbow to the forearm and back of the hand when grasping or twisting
• Weak grasp

Signs and tests

The diagnosis is made based on signs and symptoms, since x-rays are usually normal. Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow

There is also pain near the elbow when the wrist is extended (bent backwards, like revving a motorcycle engine) against resistance.

Treatment

The goal of treatment is to relieve pain and swelling. Treatment may include:

• Heat therapy
• Local injection of cortisone and a numbing medicine
• Nonsteroidal anti-inflammatory medications (such as ibuprofen, naproxen, or aspirin)
• Physical therapy
• Pulsed ultrasound to break up scar tissue, promote healing, and increase blood flow in the area
• Using a splint to keep the forearm and elbow still for 2 to 3 weeks

To prevent the injury from happening again, a splint may be worn during activities that aggravate the condition. Or, you may need to limit certain activities. If the pain persists despite nonsurgical treatments, surgery may be necessary.

Expectations (prognosis)

Most people improve with nonsurgical treatment. The majority of those who do have surgery show an improvement in symptoms.

Complications

• Failure to improve with nonsurgical or surgical treatment. This may be due to nerve entrapment in the forearm
• Recurrence of the injury with overuse
• Rupture of the tendon with repeated steroid injections

Calling your health care provider

Apply home treatment (over-the-counter anti-inflammatory analgesics and immobilization) if symptoms are mild or if you have had this disorder before and you know this is what you have.

Call for an appointment with your health care provider if this is the first time you have had these symptoms, or if home treatment does not relieve the symptoms.

Prevention

Maintain good strength and flexibility in the arm muscles or avoid repetitive motions. Rest the elbow when flexion and extension (bending and straightening) are painful. An ice pack applied to the outside of the elbow after repetitive motion may help alleviate symptoms.

References

Biundo JJ. Bursitis, tendinitis, and other periarticular disorders, and sports medicine. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 284.

Geiderman JM. Humerus and elbow. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006: chap 49.

Johnson GW, Cadwallader K, Scheffel SB, et al. Treatment of lateral epicondylitis. Am Fam Physician. 2007;76(6):843-848.

Answer 2

Definition

Tennis elbowis inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow.

There may be a partial tear of the tendon fibers, which connect muscle to bone. The tear may be at or near where these fibers begin, on the outside of the elbow.

Alternative Names

Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral

Causes, incidence, and risk factors

The part of the muscle that attaches to a bone is called a tendon. Muscles in your forearm attach to the bone on the outside of your elbow.

When you use these muscles over and over again, small tears develop in the tendon. Over time, this leads to irritation and pain where the tendon is attached to the bone.

This injury is common in people who play a lot of tennis or other racquet sports, hence the name "tennis elbow." Backhand is the most common stroke to cause symptoms.

However, any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to this condition. Therefore, painters, plumbers, construction workers, cooks, and butchers are all more likely to develop tennis elbow.

This condition may also be due to constant computer keyboard and mouse use.

Symptoms

• Elbow pain that gradually worsens
• Pain radiating from the outside of the elbow to the forearm and back of the hand when grasping or twisting
• Weak grasp

Signs and tests

The diagnosis is made based on signs and symptoms, because x-rays are usually normal. Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow.

There is also pain near the elbow when the wrist is extended (bent backwards, like revving a motorcycle engine) against resistance.

X-rays are rarely needed.

Treatment

The first step is to rest your arm and avoid the activity that causes your symptoms for at least 2 - 3 weeks. You may also want to:

• Put ice on the outside of your elbow 2 - 3 times a day.
• Take nonsteroidal anti-inflammatory medications (such as ibuprofen, naproxen, or aspirin).

If your tennis elbow is due to sports activity, you may want to:

• Ask about any changes you can make in your technique.
• Check any sports equipment you're using to see if any changes may help.
• Think about how often you have been playing and whether you should cut back.

If your symptoms are related to working on the comptuer, ask your boss about making changes.

An occupational therapist can show you exercises to stretch and strengthen the muscles of your forearm.

You can buy a special brace for tennis elbow at most drug stores. It wraps around the first part of your forearm and takes some of the pressure off the muscles.

Your doctor may also inject cortisone and a numbing medicine around the area where the tendon attaches to the bone. This may help decrease the swelling and pain.

If the pain continues after 6 - 12 months of rest and treatment, surgery may be recommended. Talk with your orthopedic surgeon about the risks, and whether surgery might help.

Expectations (prognosis)

Most people improve with nonsurgical treatment. The majority of those who do have surgery show an improvement in symptoms.

Complications

• Failure to improve with nonsurgical or surgical treatment. This may be due to nerve entrapment in the forearm
• Recurrence of the injury with overuse
• Rupture of the tendon with repeated steroid injections

Calling your health care provider

Apply home treatment (over-the-counter anti-inflammatory medications and keeping the elbow still) if:

• Symptoms are mild
• You have had this disorder before and you are sure you have tennis elbow

Call for an appointment with your health care provider if:

• This is the first time you have had these symptoms
• Home treatment does not relieve the symptoms

Prevention

To help prevent tennis elbow:

• Apply an ice pack to the outside of the elbow
• Maintain good strength and flexibility in the arm muscles and avoid repetitive motions
• Rest the elbow when bending and straightening are painful

References

Regan WD, Grondin PP, Morrey BF. Elbow and forearm. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 19.

Schmidt MJ, Adams SL. Tendinopathy and bursitis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 115.

Reviewed By

Review Date: 05/09/2011

A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine (8/3/2010).