Copyright 2007 American Academy of Orthopaedic Surgeons
Tennis Elbow (Lateral Epicondylitis)
Tennis elbow is a degenerative condition of the tendon fibers that
attach on the bony prominence (epicondyle) on the outside (lateral side)
of the elbow. The tendons involved are responsible for anchoring the muscles
that extend or lift the wrist and hand.
Chronic overuse leads to tendon degeneration, which is painful. Tennis elbow happens mostly in patients between 30 years and 50 years of age. It can occur in any age group. Tennis elbow can affect as many as half of athletes in racquet sports. However, most patients with tennis elbow are not active in racquet sports. Most of the time, there is not a specific traumatic injury before symptoms start. Many individuals with tennis elbow are involved in work or recreational activities that require repetitive and vigorous use of the forearm muscle. Some common activities that lead to epicondylitis include:
Some patients develop tennis elbow without any specific recognizable activity leading to symptoms. Common activities that lead to epicondylitis are both recreational (tennis, especially groundstrokes; racquetball; squash; and fencing) and occupational (meat cutting, plumbing, painting, raking, and weaving). Patients often complain of severe, burning pain on the outside part of the elbow. In most cases, the pain starts in a mild and slow fashion. It gradually worsens over weeks or months. The pain can be made worse by pressing on the outside part of the elbow or by gripping or lifting objects. Lifting even very light objects (such as a small book or a cup of coffee) can lead to significant discomfort. In more severe cases, pain can occur with simple motion of the elbow joint. Pain can radiate to the forearm. The diagnosis of tennis elbow begins with a complete medical history. The doctor will perform a physical examination.
X-rays are not necessary. Rarely, magnetic resonance imaging (MRI) scans may be used to show changes in the tendon at the site of attachment onto the bone. Nonsurgical TreatmentIn most cases, nonsurgical treatment should be tried before surgery. Pain relief is the main goal in the first phase of treatment.
Orthotics can help diminish symptoms of tennis elbow. The doctor may want you to use counterforce braces and wrist splints. These can reduce symptoms by resting the muscles and tendons. ![]()
Left, counterforce brace. Right, wrist brace.
Symptoms should improve significantly within four weeks to six weeks. If symptoms do not improve, the next step is a corticosteroid injection around the outside of the elbow. This can be very helpful in reducing pain. Corticosteroids are relatively safe medications. Most of their side effects (i.e., further degeneration of the tendon and wasting of the fatty tissue below the skin) occur after multiple injections. Avoid repeated injections (more than two or three in a specific site).
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Wrist stretching exercise with elbow extended.
Surgical TreatmentSurgery is considered only in patients who have incapacitating pain that does not get better after at least six months of nonsurgical treatment. The surgical procedure involves removing diseased tendon tissue and reattaching normal tendon tissue to bone (figure below). The procedure is an outpatient surgery, not requiring an overnight stay in the hospital. It can be performed under regional or general anesthesia.
So far, no significant benefits have been found to using the arthroscopic method over the more traditional open incision. After surgery, the elbow is placed in a small brace and the patient is sent home. About one week later, the sutures and splint are removed. Then exercises are started to stretch the elbow and restore range of motion. Light, gradual strengthening exercises are started two months after surgery. The doctor will tell you when you can return to athletic activity. This is usually approximately four months to six months after surgery. Tennis elbow surgery is considered successful in approximately 80 percent of patients. Last reviewed and updated: October 2007
AAOS does not review or endorse accuracy or effectiveness of materials, treatments or physicians.
Copyright 2007 American Academy of Orthopaedic Surgeons
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