Tennis elbow, which is properly known as lateral epicondylalgia, is a type of overuse injury that causes pain around the outside of the elbow. This happens when a similar movement is repeated again and again, leading to inflammation or microtearing. It is the most common cause of elbow pain.
In most cases, symptoms present gradually and worsen slowly over weeks or months. Most people experience a burning or aching pain which can also spread into your forearm and wrist. It can be aggravated by movements of the wrist and hand, such as holding your coffee cup or shaking hands and can weaken your grip strength. In some cases, a tear in the muscle or tendon can occur from a specific injury and the pain onset is usually immediate.
This condition gets its name as playing tennis or other racquet sports is a common cause. However, it can also be a result of everyday activities like gripping, typing, or chopping hard vegetables. Tennis elbow also affects certain professions more than others, including painters, carpenters, chefs and plumbers due to the repetitive nature of their labor. This leads to a higher level of loading that places stress on the tendons. It is also more common if you’ve recently returned to activity after a rest period, if you’ve increased the intensity of an activity, or if you have poor technique. While anyone can get this condition, it is more common between 30 and 50 years old.
This affects a muscle group called the common extensors. The belly of the muscles lie on the back of the forearm and the tendons run from here to attach onto a bony spot on the outside of the elbow, called the lateral epicondyle. These muscles are responsible for extending your wrist and fingers and stabilising your wrist, for example in a tennis stroke.
To diagnose this condition, your physiotherapist will ask you various questions about the nature of your pain, what aggravates it and your recreational, sporting and work activities. A physical examination might include applying pressure to the affected area, looking at your wrist and elbow range, and applying resistance to movement. In many cases, imaging isn’t necessary to make a diagnosis.
Approximately 80% to 95% of patients will have success with nonsurgical/conservative treatment. This will involve:
- Rest – relative rest from aggravating activities to reduce the level of load
- Physiotherapy – massage and dry needling to reduce muscle tightness, education of appropriate activity modification and exercise prescription
- Exercise – strengthening and stretching exercises where appropriately prescribed
- Bracing – to reduce to load going through the common extensor muscles
- Medication – anti-inflammatory and analgesic medication can help to temporarily reduce pain and swelling
If the above measures are not causing improvement after 4-6 weeks, a steroid injection into the area can be considered. Ongoing physiotherapy will assist a positive outcome after a steroid injection. If there is no improvement after 6-12 months, surgery is an option, but rarely necessary.