Tennis elbow is a painful condition caused by the swelling of the tendon that bends your wrist backward away from your palm. Your forearm muscles and tendons become inflamed and damaged from activities that involve repetitive motions like playing tennis and other racquet sports.
Signs and symptoms of tennis elbow
The common symptoms of tennis elbow include:
- Initial pain, burning, or an ache along the outside of your forearm and elbow during activity. Pain may also persist when you place your arm and hand palm-down on a table, and then try to raise your hand against resistance.
- Difficulty and pain lifting and grip small objects, such as a coffee cup.
- Weak grip.
- Worsening pain with time that can spread down to your wrist even at rest, especially if you continue the activity that caused your condition.
Causes of tennis elbow
For tennis players
If you play tennis, your tennis elbow may be caused by:
- Improper backhand stroke.
- Weak shoulder and wrist muscles.
- Using a tennis racket that is too tightly strung or too short.
- Other racquet sports, like racquetball or squash.
- Hitting the ball off center on the racket, or hitting heavy, wet balls.
Away from the court
However, many people who suffer from tennis elbow do not play tennis. The problem can be caused by any repetitive movement, including:
- Painting with a brush or roller.
- Working a chain saw.
- Frequent use of other hand tools on a regular basis.
- Using repeated hand motions in various types of work, such as butchers, musicians, dentists, and carpenters.
Your provider will perform a physical exam and an MRI scan, and possible other tests, to diagnose tennis elbow. He/she will then work with you on a treatment plan based on your symptoms and activity level. The majority of our patients heal with nonsurgical treatment alone, which can include:
- Bracing. Centered over the back of your forearm, a brace can reduce symptoms by resting the muscles and tendons.
- Extracorporeal shock wave therapy. Shock wave therapy sends sound waves to the elbow, creating microtrauma that promote the body’s natural healing processes.
- Injections. Your doctor might recommend injecting steroid injections such as cortisone, platelet-rich plasma (PRP) therapy, or Botox or some form of irritant (prolotherapy) into the painful tendon. Your provider may also recommend either dry needling or ultrasonic tenetomy (TENEX procedure), in which a needle pierces the damaged tendon in many places.
- Non-steroidal anti-inflammatory medicines. Drugs like aspirin or ibuprofen reduce pain and swelling.
- Physical therapy. A physical therapist will teach you specific exercises to stretch and strengthen the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.
- Rest. The first step toward recovery. You will have to stop participation in sports or heavy work activities for several weeks.
Surgical treatment options
If your symptoms do not respond after six to 12 months of nonsurgical treatments, your provider may recommend surgery:
- Arthroscopy. Your surgeon inserts a thin tube fitted with an HD camera and surgical tools, called an arthroscope, through a tiny incision(s) and removes damaged tissue and reattaches tendon to bone.
- Open surgery. The most common approach, involving an incision over the elbow joint.
Rehabilitation and physical therapy are critical to full recovery from tennis elbow.
Conservative treatment typically takes six to 12 months, but recovery from surgical treatment may take a bit longer to get you back in top form.
Orthoinfo: American Academy of Orthopaedic Surgeons. Tennis Elbow (Lateral Epicondylitis) (https://orthoinfo.aaos.org/en/diseases–conditions/tennis-elbow-lateral-epicondylitis/)
MedlinePlus: National Library of Medicine. Tennis elbow (https://medlineplus.gov/ency/article/000449.htm)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Tennis Elbow (https://www.ncbi.nlm.nih.gov/books/NBK431092/)