Tennis elbow

Causes

The part of the muscle that attaches to a bone is called a tendon. Some of the 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

Exams and Tests

Your doctor or nurse will examine you.  The exam may show:

• Pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow.
• Pain near the elbow when the wrist is bent backwards.

X-rays may be done.

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 are using to see if any changes may help. If you play tennis, changing your grip size of the racket may help.
• Think about how often you have been playing and whether you should cut back.

If your symptoms are related to working on a computer, ask your manager about making changes to your work station or have someone look at how you chair, desk, and computer are set up.  

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 upper 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.

Outlook (Prognosis)

Elbow pain may get better without surgery. However, most people who have surgery have full use of their elbow forearm afterwards.

When to Contact a Medical Professional

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

Alternative Names

Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral

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.

Update Date: 8/11/2012

Updated by: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc., and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery.