If it’s been some time since you swung a racket in anger, you might wonder how you’ve wound up suffering from tennis elbow! Tennis elbow, or lateral epicondylitis, is not restricted to athletes. It’s a common and painful inflammation of the where the muscles attach at the elbow.
Are you one of the 3% of Americans who are suffering from tennis elbow? Understanding the condition better is the key to ridding yourself of this worrisome issue.
Let’s take an in-depth look at tennis elbow. We’ll examine the causes, treatment options, and how to prevent a recurrence.
What Is Tennis Elbow?
Tennis elbow is a form of tendinitis, which is a general term used to describe any inflammation of the tendons.
Tennis elbow occurs from over using your extensor tendons of your fingers and wrist. Everytime you stretch out your fingers or wrist, you are using your extensor tendons. Those muscles attach to the elbow at the lateral epicondyle. When there is overuse, the area can become inflammed.
Tendons are crucial for connecting muscles to bones and other structures in the body. They help to move the bone, keeping everything in sync. They are made of fibrous connective tissue and can become inflamed due to overuse.
When the tendons and muscles around the elbow become inflamed, they cause pain around the exterior of the elbow. The pain can radiate down the forearm muscles. This makes it painful to grip things and shake hands. The pain can also continue when resting at times.
You can develop tennis elbow at any age, but it’s more common in people between the ages of 30 and 50. Both sexes are equally as likely to develop the condition. It usually develops in your dominant arm—if you are right-handed, you will probably have issues with your right elbow.
What Causes It?
Repetitive motions cause tennis elbow. Repeating the same action time and time again can strain the forearm muscles. In time, this also stresses the tendons. Microscopic tearing can result, leading to inflammation, or tendinitis.
Lateral epicondylitis got its nickname ‘tennis elbow’ because it’s a condition that is common in tennis players. About 50% will develop it at some point. The repeated motion of swinging the racket (especially backhand shots) and the shock of making contact with the ball put pressure on the forearm muscles and tendons.
Tennis is not the only sport that puts you at risk. Any sport that requires repeated forearm movements will put you at risk of developing tennis elbow. This includes squash, racquetball, and weight lifting.
Who Is At Risk?
Sportspeople are not the only ones who put their forearm muscles under repeated strain day after day at work. Many in skilled trades are affected. Carpentry, typing, painting, and decorating involve repeated movements of the forearms. This can lead to overloaded tendons. Even typing with a keyboard and keeping your hands in a narrowed position can do it (using laptop).
Many hobbies and recreational activities also require repetitive motions. Knitting and gardening are two that can cause tennis elbow to flare up.
If your job involves one of the following, you could be at risk:
- Using tools heavier than 1kg
- Lifting loads heavier than 20kg more than 10 times per day
- Making repetitive motions for more than 2 hours per day
These repetitive motions all impact the elbow. They can result in strained forearm muscles and overloaded tendons.
How Long Does It Last?
A number of factors affect how long tennis elbow lasts. These include how quickly you receive effective treatment. Tennis Elbow usually gets better with a number of different types of treatments, but time to improvement can vary, depending on the treatment.
Some cases may clear up very quickly, in a matter of weeks. These cases may not need additional treatment. Around 20% of cases of tennis elbow last for more than 12 months.
What Are the Symptoms of Tennis Elbow?
If you’re in a skilled trade or enjoy one of the sports or hobbies mentioned above, you’re likely to first notice the pain when using your hands. Although the problem is in the elbow, the pain usually comes when you try to grip something.
The pain in the elbow will likely be present at a low level much of the time. When you strain the forearm muscles and the tendons, the pain will increase. You will experience tenderness and pain around the bony knob on the outside of your elbow.
This is likely to happen when you do something as mundane as shaking hands, picking up a cup of coffee, or opening a door. Some sufferers find it hard or very painful to fully straighten or raise their arm. Pain levels can vary in intensity during the day. Pain during the night may cause sleep disruption as well.
The Progression of Tennis Elbow Symptoms
Without early treatment, tennis elbow will go through four stages of development. The intensity of the symptoms will gradually get worse as the condition progresses.
- Stage 1 – mild pain a couple of hours after the activity that strains the muscles
- Stage 2 – pain immediately after activity that strains the muscles
- Stage 3 – pain during the activity, which gets worse after stopping the activity
- Stage 4 – constant pain, making it impossible to do any strenuous activities
A common complaint among sufferers is a weak grip, or difficulty carrying objects in their hands. This is particularly true if you extend your arm, such as when carrying a plate or a hot pan.
How Is Tennis Elbow Diagnosed?
If these symptoms sound familiar to you, it’s likely you’re suffering from tennis elbow. If you have pain on the inside of the elbow, this could be golfer’s elbow—another form of tendinitis. Symptoms alone are not enough for an accurate diagnosis. There are other causes of elbow pain that your doctor will want to rule out.
Your doctor will take you through a range of arm movements to observe what causes you pain and exactly where the pain is coming from. You may also need an x-ray or MRI to understand exactly what’s going on.
This will also help to rule in or out other elbow problems, such as bursitis or trapped nerves. This is the condition called cubital tunnel syndrome. It is similar to the more well-known carpal tunnel syndrome. It can cause symptoms that can be confused with lateral epicondylitis. Radial tunnel syndrome is another diagnosis that has to be differentiated.
An ultrasound scan can also be useful for assessing the degree of tendon damage. This can also diagnose the presence of bursitis.
Treating Tennis Elbow
For some people, tennis elbow is a short-term issue. They may find that it passes within a couple of weeks, especially if they temporarily stop any activities that put a strain on the elbow.
For other people, the problem can persist for many months, even for years. Let’s explore treatment options for different stages of this condition.
Non-Operative Treatment for Tennis Elbow
Non-operative treatment of tennis elbow tries to achieve two goals. It tries to control inflammation and relieve pain. If the pain is severe, NSAIDs can be prescribed. However, these will only treat the pain and not the underlying cause of the tendinitis.
Rest and Ice
Your doctor or physiotherapist will often recommend a period of rest for your elbow. This means complete avoidance of the activity that you have identified as the cause of the strain on the forearm muscles.
Ice can be an effective treatment for inflamed tendons. Apply ice to the affected area three times a day for 15 minutes. This reduces swelling through vasoconstriction—constricting the blood vessels. This also reduces the level of chemical activity in the area.
Sufferers can wear a brace on their forearm to reduce the pressure normally put on the tendon while doing everyday activities. With reduced pressure on the tendon, it is able to rest and heal more quickly.
In-office sessions of physical therapy will use ultrasound to increase blood flow to the area. Additionally, extracorporeal shock wave therapy delivers shock waves to the injured tendons. This creates micro-trauma which helps the tendon to heal more quickly.
You will follow up with exercises that you can perform at home to rebuild the strength of muscles in the forearm.
With this form of treatment, the steroid cortisone is injected into the area around the affected tendon. Initially, pain may increase for the first 24-48 hours. You will need to rest the elbow for one to two weeks. The effects of the injection last for around three months. The injection can only be given twice. A single steroid injection can sometimes permanantly resolve the pain.
Surgical Options for Treating Tennis Elbow
Surgery is an option for patients that are refractory to conservative treatment.
The goal of surgery is improve pain with use of extensor tendons. The procedures are short, with a quick recovery. Fascia is usually one of the main areas that need to be addressed, as that tight white external tissue around muscle can be problematic. The fascia – the white, shiny coating on the muscle – can also become tight in cases of tennis elbow. Surgery can help by releasing this tight white fascia.
Open surgery for tennis elbow involves making an incision over the elbow. Diseased tissue is removed, and tension is released. This is a very quick procedure, taking only a few minutes. It is performed as an outpatient procedure, and it is very unlikely you will have to stay overnight.
Recovery from this type of surgery takes about three weeks for the initial recovery. This is followed up with physical therapy, meaning the whole treatment is usually completed within six months.
Arthroscopic surgery works the same way as open surgery and provides the same outcomes. The benefit is that it is much less invasive. It makes a much smaller incision. A no-stitch approach is possible, leading to faster recovery times from the initial surgery.
While the initial recovery time is faster, you will still require physical therapy after surgery. It will take 4-6 months to restore full, pain-free use of the forearm and elbow.
The Tenex procedure is the least invasive procedure for treating tennis elbow. The surgeon will insert a Tenex ultrasonic needle through a tiny incision near the affected tendon.
The surgeon then uses ultrasound to identify scar tissue on the tendon. The needle is then used to break this down and remove it. Healthy tissue is left intact and the very small incision heals quickly.
The advantage of this treatment is that recovery times are fast. Typically, normal use of the elbow can resume in 4-6 weeks. If your doctor prescribes a course of physical therapy though, this may take longer.
How to Avoid Recurrence of Tennis Elbow
Tennis elbow is a painful condition that can take months—and even surgery—to heal. Everyone who has had it will be thinking— how can I make sure I never get this again?
Prevention is not easy, as we use our forearm muscles a lot. However, there are some practical steps that everyone can take to keep their muscular skeleton system in good shape.
- Get advice to help you perform repetitive movements in a way that reduces strain
- Warm-up your muscles before doing any activity that requires repetitive movements
- Use lightweight tools (ideally under 1kg) for repetitive tasks
- Regularly exercise your forearm muscles to increase their strength
The correct technique when lifting and performing repetitive motions is very important. This will help to use other muscles, such as the larger muscles of the shoulders. It will reduce the strain on the forearm muscles, which in turn strain the tendons.
Effective Treatment for Tennis Elbow
Tennis elbow can be a real drag. It can get in the way of doing the things you love. It can even affect your ability to make a living. But don’t despair. With proper treatment, it can go away. You can experience full use of your hand, forearm, and elbow once again!
Effective treatment for tennis elbow starts with an accurate diagnosis. Hand Surgery Specialists of Texas are here to help. We’re the experts in both non-surgical and surgical treatment options for tennis elbow.
Contact us today to take the first step on your journey to pain-free forearms and elbows!