Tennis Elbow: Signs and Symptoms, Causes, Risks, Complications, Diagnosis, Treatment and Prevention

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A tennis player with tennis elbow

Overview

The joints in the body are important for motion and mobility. If they are not working properly, it will lead to pain, inflammation and mobility issues. Though the elbow is not a weight-bearing joint, it’s vital for movement of the arms and hands. If there is a problem with the elbow, moving the hands would be difficult and painful.

One of the most common conditions that can affect the elbow is lateral epicondylitis or tennis elbow. Tennis elbow is a very painful condition that happens when the tendons in the elbow become inflamed and overloaded, due to strenuous overuse and repetitive movements.

Though it’s dubbed as tennis elbow, athletes are not the only ones who experience this condition. Other individuals whose jobs involve the motions that could lead to tennis elbow can be affected too. They include painters, butchers, carpenters, and plumbers.

There are various treatment options for tennis elbow. In most cases, the treatment needs a team approach from many health care workers like doctors, surgeons, and physical therapists. They provide the most effective care.

Tennis elbow is believed to affect about 1 to 3 percent of the people in the United States. Usually, it happens between the ages of 30 and 50 years old.

Signs and Symptoms

The major signs and symptoms of tennis elbow are a pain, tenderness, and inflammation that may radiate outwards when the elbow and wrist are moved in some ways like:

  • Straightening the fingers against resistance
  • Bending the wrist while the elbow is straight
  • Bending the hand back against resistance while the elbow is straight
  • Straightening the wrist against resistance when the elbow is also straight

The common signs and symptoms of tennis elbow include:

  • Pain or burning sensation on the outer part of the elbow
  • Weakened grip strength in the affected arm
  • These worsen with activities of the forearm like holding a racquet, shaking hands or turning a wrench.
  • Pain usually on the dominant hand, but both hands can also be affected

Causes

Tennis elbow is usually an overuse injury and muscle strain injury. The cause is usually the repeated contraction of the muscles in the forearm that are used to straighten or raise the wrist and hand. These movements and repeated stress may lead to small tears in the tendons. Also, inflammation can develop near the lateral epicondyle or bony lamp on the outside part of the elbow.

Many studies have shown that tennis elbow is usually due to damage to a particular forearm muscle called the extensor carpi radialis brevis (ECRB). This muscle stabilizes the wrist when the elbow is straight. The overuse of the muscle arises from many activities. When there is overuse of the muscle, it weakens and microscopic tears form in the tendon where it attaches to the lateral epicondyle. As a result, pain and inflammation occur.

Some activities can develop tennis elbow such as:

  • Playing racquet sports like badminton or tennis
  • Using shears during gardening
  • Sports that involve throwing like shotput, javelin or discus
  • Painting (using paintbrush or rollers)
  • Plumbing
  • Bricklaying
  • Using scissors or typing on the computer
  • Activities that need repeated elbow movements like violin

Risk Factors

Some factors may increase the risk of developing tennis elbow, such as:

Age – The condition is more common in people between the ages of 30 and 50. However, it can affect people of all ages. In racquet sports, improper stroke technique may be risk factors, too. So, it can affect everyone.

Certain sports – As stated earlier, certain sports like those involving the use of racquets may increase one’s risk of developing tennis elbow.

Job – Some individuals who work as painters, plumbers, cooks, carpenters, and butchers, who involve repetitive hand and elbow movements are at a higher risk of developing tennis elbow.

Complications

  • Tendon rupture with repeated injections of steroids
  • Recurrence of injury due to overuse of muscle
  • Severe pain due to nerve entrapment

Diagnosis

The doctor will determine various factors in making a diagnosis. These include the risk factors, occupational risks, the involvement in sports activities and how the symptoms started. Initially, he will conduct a medical history interview and a complete physical examination.

During the physical exam, the doctor may check the affected area and ask you to move your elbow, fingers, and wrist. The doctor will use a variety of tests to pinpoint the diagnosis. For instance, the doctor will ask you to straighten the fingers or wrist against resistance.

Also, the doctor will ask about what activities cause pain or the exact location of the pain. The other diagnostic tests include:

X-ray – The X-ray will provide clear and detailed images of the dense structures of the body such as the bones. This test will be used to rule out arthritis of the elbow, that can cause the same symptoms of tennis elbow.

Electromyography (EMG) – This procedure is used by the doctor to rule out any nerve compression or impingement. There are various nerves traveling around the elbow, and nerve compression symptoms are similar to a tennis elbow.

Magnetic resonance imaging (MRI) – An MRI scan is needed to show details of soft tissues to determine any problem in the elbow. Also, it can also rule out any problems in the neck or spinal column, because a herniated disk may cause pain in the arm.

Treatment

Tennis elbow is usually a self-limiting condition that means it will get better even without treatment. However, the duration depends on how the tendons will heal. In some cases, it can persist for more than a year.

Many treatments can help reduce the pain and inflammation caused by tennis elbow. The most important thing to do is to rest the arm and stop performing the activity that had caused the problem.

Physical Therapy – A physical therapist can educate you to gradually stretch and strengthen the elbow and muscles, particularly in the forearm. He or she can also teach eccentric exercises, which involve lowering the wrist slowly and raising it again. You can be advised to wear a forearm brace or strap to alleviate the stress on the tissue involved.

Avoiding and modifying activitiesThe main treatment to the condition is to avoid the activities that aggravate the pain. However, if you are not able to give up the activity, the sport or the occupation, you can modify these activities to lessen the stress on the affected muscle.

If you have a tennis elbow, you can stop the activities that strain the affected muscles and tendons. You can avoid lifting and other activities until the pain and inflammation improve.

Pain relievers – Pain relievers and anti-inflammatory drugs can be recommended by the doctor to reduce pain and to swell in the affected arm. Aside from oral medicines, topical medicines like creams can be used, particularly for musculoskeletal conditions like tennis elbow.

Injections – The doctor may recommend using injections of platelet-rich plasma or Botox into the affected tendon.

Shockwave therapy – Shock wave therapy is a non-invasive treatment option that uses high-energy shock waves to relieve pain and induce movement in the affected area.

Ultrasonic tenotomy (TENEX) – This procedure involves the use of ultrasonic energy to vibrate the needle inserted into the damaged tendon. As a result, the tissue becomes liquid and can be suctioned out.

Surgery – If the symptoms do not improve after treatment, surgery can be recommended to remove the damaged tendon or tissue.

Prevention

To reduce the risk of developing tennis elbow, it is important to note important techniques during exertion or exercise. Spread the load to the larger muscle groups of the upper arm and shoulder than using the small arms in the forearms and wrist.

Here are ways to prevent tennis elbow:

Warm up – Before playing a sport, working out or movement, warm up by stretching the arm muscles. This will help prevent injury.

Increase forearm muscle strength – Increasing the strength of your forearm muscles can help support arm movement. This will also help prevent tennis elbow. There are some exercises that can help strengthen the muscles in the forearm.

Use lightweight tools – Use lighter tools like racquets and sports equipment with larger size grip to reduce due strain on the muscles and tendons.

Stop doing the activity causing pain – To prevent tennis elbow, stop the activity that places stress on the tendons.

Other preventive measures include:

  • Avoid using the elbow and wrist more than the rest of the arm. It’s better to spread the load to the larger muscles of the upper arm and shoulder.
  • If you play repetitive movements sports like tennis, try to improve your technique to reduce the risk of tennis elbow.
  • Wear a tennis elbow splint to prevent further damage to the tendon and muscles.
  • Visit your physical therapist regularly
  • Exercise your arms and hands regularly
  • Do not overuse your arm, rest if you feel tired or they feel sore.
  • Avoid exerting too much effort using the arm, elbow, and
  • Learn about the activities that could trigger a tennis elbow. Modify activities to prevent getting the condition or worsening it if you have it already.