What is Tennis Elbow?
Tennis elbow involves the tendons that connect the forearm muscles to the outer part of the elbow bone (the lateral epicondyle). These muscles are primarily responsible for extending your wrist and fingers (bending your wrist backward away from your palm). Overuse or repeated strain on these tendons can lead to small tears, inflammation, and degeneration, causing pain and tenderness.
Causes of Tennis Elbow
The root cause of tennis elbow is often overuse and repetitive strain on the forearm muscles and their tendons. This can stem from various activities, including:
- Sports:
- Tennis: Especially with improper backhand technique, excessive topspin, or using a racquet that's too heavy or has an incorrect grip size.
- Other racquet sports like squash or badminton.
- Throwing sports (e.g., javelin, baseball).
- Weight training (improper technique, like curling wrists during biceps exercises).
- Occupational Activities:
- Carpentry
- Plumbing
- Painting
- Meat cutting
- Typing or extensive computer work (especially with improper mouse use)
- Gardening
- Any job involving repetitive gripping, twisting, or lifting of the wrist and forearm.
- Other Activities:
- Using scissors
- Cutting tough food
- Sewing
- Playing certain musical instruments
Contributing factors can include:
- Poor technique during activities.
- Lack of proper warm-up and stretching.
- Weakness in forearm muscles.
- Using equipment that's too heavy or improperly sized.
- Smoking, obesity, high fat diet, high cholesterol, and diabetes can also affect tendon health.
Symptoms of Tennis Elbow
The primary symptom of tennis elbow is pain and tenderness on the outside of the elbow, which may radiate down the forearm towards the wrist. The pain can range from a mild ache to a severe burning sensation and may worsen with:
- Lifting or bending the arm.
- Gripping objects (e.g., shaking hands, holding a coffee cup, turning a doorknob, opening a jar).
- Moving or twisting the wrist.
- Pressing on the outside of the elbow.
Other symptoms can include:
- Weakness in the forearm or grip.
- Difficulty fully straightening the arm.
- Swelling around the elbow (if there's tendinitis/inflammation).
Diagnosis
A healthcare professional can usually diagnose tennis elbow based on a physical examination and a review of your symptoms and activities. They may perform specific movements to pinpoint the pain. In some cases, imaging tests like X-rays, ultrasound, or MRI might be used to rule out other conditions or assess the extent of tendon damage.
Treatment Options
Most cases of tennis elbow improve with conservative treatment and self-care, though it can sometimes take several months to a year or more for full recovery.
Initial Self-Care and Conservative Treatments:
- Rest: Avoid or modify activities that aggravate your elbow pain. This is crucial for allowing the tendons to heal.
- Ice: Apply ice packs to the affected area for 15-20 minutes, 3-4 times a day, to reduce pain and inflammation.
- Over-the-counter pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and swelling. These can be taken orally or applied topically as a gel.
- Elbow support/brace: A forearm strap or brace worn just below the elbow can help reduce stress on the injured tendons.
Physical Therapy and Exercises:
Once the initial pain and swelling subside, a physical or occupational therapist can guide you through exercises to strengthen and stretch the forearm muscles. This is vital for long-term recovery and preventing recurrence. Exercises may include:
- Wrist Extensor Stretch: Straighten your arm, relax your wrist so your hand hangs down, and gently use your other hand to bend your hand further towards you.
- Wrist Flexor Stretch: Straighten your arm, relax your wrist, and gently pull your fingers towards you with your other hand.
- Wrist Curls: With a light weight, rest your forearm on a table, palm up (for wrist flexion) or palm down (for wrist extension), and slowly raise and lower the weight using only your wrist.
- Supination/Pronation: With a light weight (like a hammer or small dumbbell), rotate your forearm to turn your palm up and down.
- Grip Strengthening: Squeeze a soft ball or rolled-up towel.
- Towel Twists: Twist a towel with both hands in opposite directions.
Other Treatments (if conservative methods aren't enough):
- Corticosteroid Injections: Can provide short-term pain relief, but repeated injections might hinder the long-term healing process.
- Platelet-Rich Plasma (PRP) Injections: Involves injecting a concentrated solution of your own blood platelets into the affected area to promote healing. Evidence for its effectiveness is mixed.
- Dry Needling / Needle Fenestration: A needle is used to gently pierce the damaged tendon multiple times to stimulate a healing response.
- Ultrasonic Tenotomy (TENEX procedure): Uses ultrasound guidance to remove damaged tissue with a specialized vibrating needle.
- Extracorporeal Shockwave Therapy (ESWT): Delivers shock waves to the injured tissue to stimulate healing.
- Surgery: Rarely needed, but may be considered if symptoms persist for 6-12 months despite other treatments. It involves removing damaged tissue.
Prevention
Preventing tennis elbow often involves modifying activities and strengthening your arm.
- Warm up and stretch before engaging in sports or repetitive activities.
- Use proper technique for sports or work tasks. Consider coaching for sports to ensure correct form.
- Use appropriate equipment: For example, lighter racquets with a larger grip size can reduce strain.
- Strengthen forearm muscles and the larger muscles of the shoulder and upper arm.
- Take regular breaks during repetitive tasks.
- Listen to your body: If you feel pain, stop the activity and rest.
- When lifting, try to keep your palms facing your body and arms bent to shift the load to larger muscles like your biceps.
Tennis Elbow vs. Golfer's Elbow
While both are overuse injuries affecting the elbow, they differ in location:
- Tennis Elbow (Lateral Epicondylitis): Pain on the outside of the elbow, affecting the tendons that extend the wrist and fingers.
- Golfer's Elbow (Medial Epicondylitis): Pain on the inside of the elbow, affecting the tendons that flex the wrist and fingers (e.g., gripping, twisting motions).
Understanding the distinction is important for accurate diagnosis and targeted treatment. If you suspect you have tennis elbow, consult a healthcare professional for proper diagnosis and a personalized treatment plan.