One of the most common causes of elbow pain in adults is lateral epicondylitis (tennis elbow), a form of elbow tendonitis. Tennis elbow causes pain at the bony point (the epicondyle) on the “outside” of the elbow. Many patients with these conditions do not even play golf or tennis, but often are physically active in other ways, through sports or work. Almost all patients affected by tennis and golfer’s elbow are between 30-60 years old.
Tennis Elbow Symptoms
Tennis elbow affects the extensor carpi radialis brevis (ECRB) tendon where it is attached to the lateral epicondyle of the elbow and can be considered a form of tendonitis. This tendon is one of the several tendons that work to extend the wrist. Though symptoms often start suddenly or with an injury, the pain is not usually caused by a “tear” or “rupture” of the tendon except in very violent injuries. Whether the tendon is “torn” or “ruptured” does not usually change the course of treatment, in any case.
Patients usually have a very localized pain (i.e. can point at the site of maximum pain with one finger) and the pain may radiate down the back of the forearm. Gripping and grasping and especially lifting anything with an overhand grip (i.e. a handbag, toolbox, etc.) aggravates the pain at the elbow and forearm. Though it may hurt to move the elbow, most patients have full elbow range of motion and do not have any mechanical symptoms such as clicking or locking of the joint.
The diagnosis of tennis elbow is almost always made by a simple physical exam. Usually X-rays, MRI, and other tests are unnecessary though the physician may order one if there are atypical symptoms (lack of full motion, mechanical symptoms, pain that is not classic for tennis elbow).
Tennis Elbow Treatment
The most important thing to keep in mind is that tennis elbow is a benign condition. Though it is painful, no harm will come to the arm or elbow by delaying treatment, and eventually the condition will resolve on its own (though this may take quite a long time). In all cases, treatment should start with conservative measures. These include:
- Modification of how the hand is positioned for lifting (i.e. use an underhand grip, not overhand).
Mills stretching exercises.
- Use of a tennis elbow brace (counterforce strap).
- Occasional use of heat and ice packs. Many patients ask if heat or ice is better and there is no agreement on the right answer. Both should be tried, and whichever feels better is the one that should be used.
- Over-the-counter anti-inflammatories such as acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Motrin).
- Physical therapy. This usually involves 1-2 visits per week to a PT over the course of 6-8 weeks. Many different methods of treating the pain are employed, including further stretching/strengthening, manipulation, taping, or even ultrasound/electrical stimulation of the painful area.
Arthroscopic Surgery for Tennis Elbow
Tennis Elbow Prognosis
Many patients worry that, left untreated, they will live with elbow pain for the rest of their lives and this is not true. Even with no treatment (i.e. ignoring the problem) many patients with tennis elbow will experience spontaneous disappearance of the pain over time. However, this has been known to take years in some individuals. Therefore, all of the treatment measures for tennis elbow can be considered palliative (i.e. treating pain only).