What is tennis elbow?
Tennis elbow, or lateral epicondylitis, is a painful elbow condition caused by overuse. It is not surprising that playing tennis or other racquet sports can cause this condition. However, various other sports and activities besides sports can also put you at risk.
Tennis elbow is an inflammation or, in some cases, a micro tear of the tendons that attach the muscles of the forearm on the outside of the elbow. The muscles and tendons of the forearm are damaged by overuse, repeating the same movements over and over. This chief to pain and tenderness on the outside of the elbow.
There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary care physicians, physical therapists, and in some cases surgeons work together to provide the most effective care.
Causes of tennis elbow
The pain is concentrated on the outside of your arm, where your forearm meets your elbow.
It is related to the muscle and tendons in the forearm. Tendons connect your muscles to your bones. When you repeat certain arm movements, the tendons at the elbow end of a certain muscle, the extensor carpi radialis brevis (ECRB), can suffer small tears.
Tears can put pressure on the rest of the arm, making it painful to lift and grasp things. If left untreated, the pain can last for a long time.
Symptoms of tennis elbow
You may experience some of the following symptoms if you have tennis elbow:
- Pain in the elbow that is mild at first but gradually worsens
- Pain that spreads from the outside of the elbow to the forearm and wrist
- A weak grip
- Increased pain when trembling hands or squeezing an object
- Pain when lifting somewhat, using tools, or opening jars
Tennis elbow treatment
- Tennis elbow is a self-limiting disorder, which means that it will finally get better without treatment.
- Though, it can often last for several weeks or months, because tendons heal slowly. In approximate cases, tennis elbow can persist for more than a year.
- Several simple treatments can help relieve tennis elbow pain. The most important thing you can do is rest your injured arm and stop doing the activity that caused the problem (see below).
- Holding a cold compress, such as a bag of frozen peas wrapped in a towel, against your elbow for a few minutes several times a day can help relieve pain.
- Invasive treatments, such as surgery, will normally only be considered in severe and persistent cases of tennis elbow, where non-surgical approaches have not been real.
Avoid or modify activities
- If you have a tennis elbow, you should stop doing activities that stress the affected muscles and tendons.
- If you use your arms at work to perform physical tasks, such as lifting, you may need to avoid these activities pending your arm pain improves.
- Alternatively, you can modify the way you perform these types of movements so that they don’t put pressure on your arm.
- Talk to your employer about evading or modifying activities that could worsen your arm and make the pain worse.
Pain relievers and NSAIDs
- Taking pain relievers, such as acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help dismiss mild pain and inflammation produced by tennis elbow.
- In addition to tablets, NSAIDs are also available in the form of creams and gels (topical NSAIDs). They are applied directly to a specific area of your body, such as the elbow and forearm.
- Topical NSAIDs are often optional for musculoskeletal conditions, such as tennis elbow, rather than anti-inflammatory tablets. This is since they can reduce inflammation and pain without causing side effects such as biliousness and diarrhea.
- Some NSAIDs are available without a prescription, while others are only available by prescription. Your GP or pharmacist will be able to recommend a suitable NSAID for you.
- Your GP may refer you to a physical therapist if your tennis elbow causes additional severe or persistent pain. Physical therapists are healthcare professionals who use a variety of methods to restore movement to injured areas of the body.
- Your physical therapist may use manual therapy techniques, such as massage and manipulation, to relieve pain and stiffness and to stimulate blood flow to your arm. They can also display the exercises you can do to keep your arm moveable and strengthen your forearm muscles.
- Wearing an orthosis, such as a brace, bandage, support bandage, or splint, may also be recommended in the short term.
- Steroids are a type of medicine that contains artificial versions of the hormone cortisol and are sometimes used to treat particularly painful musculoskeletal problems.
- Some people with tennis elbow may be offered steroid injections when other treatments have not worked.
- The injection will be given directly to the painful area around the elbow. A local anaesthetic may be given first to numb the area and reduce pain.
- Steroid injections are likely to only provide short-term relief, and their long-term effectiveness is poor. If they are helping you, they may offer you up to 3 injections in the same area, with at least 3-6 months between them.
Shock wave therapy
- Shock wave therapy is a non-invasive treatment, in which high-energy shock waves pass through the skin to help relieve pain and promote movement in the affected area.
- The number of meetings you will need will depend on the severity of your pain. You may be given a local anaesthetic to decrease any pain or discomfort during the procedure.
- The National Institute for Excellence in Health and Care (NICE) states that shock wave therapy is safe, although it can cause minor side effects, such as bruising and redness of the skin in the area to be treated.
- Research shows that shock wave therapy can help improve tennis elbow pain in some cases. However, it may not work in all cases and more research is needed.
- Platelet Rich Plasma (PRP) is a newer treatment that a surgeon can offer in the hospital to treat tennis elbow.
- PRP is blood plasma that contains concentrated platelets that your body uses to repair damaged tissue. PRP injections have been shown to speed up the healing process in some people, but their long-term effectiveness is not yet known.
- The surgeon will take a sample of your blood and place it in a machine. This separates the healing platelets so they can be taken from the blood sample and injected into the affected joints. The procedure usually takes about 15 minutes.
Surgery may be recommended as a last resort treatment in cases where tennis elbow causes severe and persistent pain. The damaged part of the tendon will be removed to relieve painful symptoms.
Diagnosis of tennis elbow
There are several things your doctor will do to diagnose tennis elbow. First, they will review your medical history and lifestyle. Then, your elbow and arm will be examined for pain, swelling, and stiffness. They can also move their arm, elbow, wrist, and fingers. Your doctor may order an X-ray or MRI of your arm. These tests help ensure that you do not have a break or fracture.
Complications of tennis elbow
Complications of tennis elbow include:
- Recurrence of the overuse injury.
- Tendon rupture with repeated steroid injections.
- Not improve with non-operative or operative treatment; These may be due to entrapment of a nerve in the forearm.
Risk factors for tennis elbow
Factors that can increase your risk for tennis elbow include:
- Years: While tennis elbow affects people of all ages, it is most common in adults between the ages of 30 and 50.
- Occupation: People who have jobs that involve repetitive wrist and arm movements are more likely to develop tennis elbow. Examples include plumbers, painters, carpenters, butchers, and cooks.
- Certain sports: Participation in racquet sports increases your risk of tennis elbow, especially if you use a poor hitting technique.
Prevention of tennis elbow
Stopping or reducing repetitive activities and resting your arm can help recovery. When rest is not possible, adjusting your arm movements can help relieve symptoms. For example, a person may try to keep the palms of the hands flat and the elbows bent when lifting.
Doing exercises designed for your tennis elbow help strengthen your forearm muscles and improve function. People whose jobs involve repetitive forearm movement should perform these exercises to prevent tennis elbow from returning.
Always consult a physician before attempting tennis elbow exercises. A doctor can make sure that the exercises do not affect any underlying conditions or injuries. If exercising the forearms seems to make tennis elbow symptoms worse, a person can try:
- Resting the arm for longer
- Wearing an ice pack on your arm to help reduce swelling
- Taking over-the-counter medications, such as ibuprofen, to relieve pain and inflammation
- Talk to a doctor or physical therapist to make sure they are doing the exercises correctly