Tennis Elbow (Lateral Epicondylitis)

What Is Tennis Elbow?

Tennis.Tennis elbow is an overuse injury caused by stress to the outside of the elbow.  The disorder is common in people who perform racquet sports, but can also occur in baseball and golf.  Repetitive activities, such as gardening, plumbing, computer or construction work, also increase the risk of this condition.  Rather than an inflammatory condition (causing swelling), it is a painful disorder caused by the breakdown of one of the extensor tendons of the wrist.

The following factors contribute to the injury:

  • Repeated wrist extension
  • Playing racquet sports with too large of a grip size
  • Lack of muscle strength and flexibility
  • Direct trauma to the outside of the elbow 

If untreated, the condition can worsen, leading to chronic pain. The good news is that tennis elbow will often heal completely with rest and a dedicated rehabilitation program. Depending on the severity of the disorder, healing can take weeks to months for resolution. 

Symptoms of tennis elbow include:

  • Pain to the outside of the elbow
  • Pain in the elbow with gripping such as turning a door knob or shaking hands
  • Decreased serve speed and/or accuracy

A doctor will complete a detailed physical exam and may order imaging tests. The diagnosis of tennis elbow is often made without the use of X-rays.  However, X-rays can be helpful to rule out other causes of elbow pain.  X-ray imaging can be done while your child is in the clinic.  In certain cases, an MRI may be helpful. 

Types of diagnostic tests:

  • X-ray:  the most common test for an elbow injury
  • Magnetic resonance imaging (MRI):  provides a more detailed image of both soft tissues and bone.  It can look at tendons and ligaments, which cannot be seen with X-rays alone. It is particularly important in tennis elbow to detect the degree of tendon degeneration.

Once the diagnosis of tennis elbow is made, your doctor will determine the best possible treatment plan.

Conservative management:

  • Rest – your doctor may suggest you avoid sporting activities for a period of time.
  • Ice – this helps to decrease pain in the elbow.
  • Physical therapy – under the guidance of a certified physical therapist, your child will undergo a strengthening and stretching regimen that will focus on strengthening of the wrist, elbow and shoulder muscles.
  • Wearing an elbow strap called a counterforce brace can be beneficial.
  • Non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naproxen, can help with pain relief.
  • Corticosteroid injection – corticosteroid injection has not been shown to alter the long-term outcome of tennis elbow.  However, for those who are in significant discomfort, it can provide temporary relief and allow the patient to proceed with physical therapy. 

Though rarely performed, shock wave therapy and surgery can be performed to treat this condition.

Some tips for preventing injury include:

  • Warm-up and cool-down exercises before and after racquet sport play, including stretching the muscles in the forearm.
  • Strengthening the muscles in the forearm.
  • Use the proper size grip and strings in racquet sports.   Racket handles that are too large can put more stress on the elbow.
  • Poor technique can contribute to increased stress on the elbow.  Improving technique can greatly reduce repetitive stress to the elbow.

Last Updated 06/2015