Tennis Elbow

Tennis Elbow

  The term “tennis elbow” is a lay-term for a condition whose medical name is lateral epicondylitis of the elbow.  Although often found in tennis players, it can occur in individuals who never play tennis.  It is usually an overuse injury to the tendons on the outside aspect of the elbow.  These are the same tendons that allow one to actively bend the wrist back.  If you lay your forearm on a counter with the palm facing down and then lift your clenched fist off the counter, you are using the muscles that we are talking about.  These muscles originate as tendons from a small area of bone on the outside aspect of the elbow.  If you extend your arm in front of you so that the palm is facing up to the ceiling, this is the part of the elbow on the same side as your thumb.  In tennis elbow, this outside aspect of the elbow is the area of maximum pain.  The pain can sometimes radiate on top of the forearm a little bit.  There is usually no numbness or tingling involved with this condition. 
  What causes tennis elbow?  The start of tennis elbow is thought to be an injury that causes a small tear in the origin of these muscles.  Sometimes this is a one-time injury.  More commonly, however, it is a repetitive overuse injury.  Once the injury occurs, instead of a normal healing response, the body sometimes creates an ongoing process in which the tissue is not repaired but actually partially degenerates.  This is why this problem can be so persistent.
  Most of the time, this can be treated without surgical intervention.  However, it can take up to two years in order for this to occur.  In order to treat this successfully, we need to avoid the offending activity.  If you are a tennis player, you may need to modify your grip size and/or correct swing mechanics in order to take the stress off the injured area.  Some players might even need to restrict playing for a time, and then slowly return to those activities which do not cause them discomfort.  Also, the way we grasp or lift things may need to be modified in order to decrease discomfort in this area.
  In addition to activity modification, bracing can be used to decrease stress on the injured area.  These are typically braces that look like thick bands that are wrapped around the forearm just below the elbow.  They need to be worn only when doing activities that cause discomfort, such as playing tennis or grasping or typing.
  The mainstay of treatment for tennis elbow consists of an exercise program.  The exercises are designed to stretch and strengthen the injured area in order to stimulate a correct healing response.  These exercises are done with high repetitions of about 20-25 per set and about 3-5 sets per workout.  These should be done daily, and one should use very light weight.  The average individual should use no more than 2 to 3 lbs.  A very strong individual should use no more than 5 to 10 lbs.
  Sometimes, however, the tennis elbow is too inflamed and painful to do much of the exercises or regular activities.  In this situation, an injection of corticosteroids into the inflamed area can help decrease inflammation and pain to where the exercises can be performed.  These injections can be repeated a couple of times, if needed.  However, the cumulative effect of repeated steroid injections is detrimental to the health of tendons and can cause numerous local problems including complete tendon rupture.  One must, therefore, be careful not to keep going back for repeated injections of steroids into the area of tennis elbow.
  In a small percentage of individuals, conservative treatment fails and painful tennis elbow persists causing discomfort and limited function.  In these cases, surgical procedures can be performed. The results of surgery can be dramatic.  However, it can take many months to recover from this surgical intervention.  During this time, activities performed with that arm are restricted.
Exercises for tennis elbow and golfer's elbow.  The upper two figures demonstrates stretches that should each be held for one minute. The lower two figures depict strengthening exercises (reverse wrist curls and wrist curls, respectively). These should be done slowly and with control, using a light and very thin weight, aiming for a high number of repetitions, as described above. In severely symptomatic patients, these strengthening exercises should be initially performed with either no weight, or gripping a pencil.