What is Tennis Elbow?
Tennis elbow, known as lateral epicondylitis, is defined as pain along the lateral (outside) aspect of the elbow joint. The condition is caused by repetitive motion injury to the tendons that attach the extensor muscles of the forearm. These are the muscles responsible for bending the wrist back. While lateral epicondylitis is common to tennis players (hence the name “tennis elbow”), it commonly occurs in non athletes as well. Individuals engaged in repetitive physical labor, such as plumbers or painters, are also susceptible to tennis elbow.
Elbow Anatomy
The elbow joint is formed by the articulation of the humerus (upper arm long bone) the radius (smaller, outer forearm bone) and the ulna (larger, inner forearm bone). The joint is stabilized by two ligaments – the medial (inner) and the lateral (outer) collateral ligaments. Tendon attachments surround the joint, enabling normal movement. Tennis elbow symptoms are the result of injury to the outer, extensor tendon at its attachment to the elbow.
Symptoms
Individuals with lateral epicondylitis experience severe burning pain along the outside aspect of the elbow. Symptoms are exacerbated by gripping or lifting even light objects. The pain may be localized to the outside of the elbow, or may radiate down the forearm.
Diagnosis
Tennis elbow is diagnosed primarily by history and physical examination. While taking a history, the doctor will try to elicit information regarding repetitive motion activities as a possible cause of the patient’s pain. The physical examination consists of testing the range of motion of the elbow, and directly pressing on the outside of the elbow, in an attempt to illicit point tenderness. In unusual cases, an MRI scan may be ordered, to evaluate the tendons and ligament of the elbow. Plain x-rays are usually not taken, as they are of little value in evaluating soft tissue structures such as tendons.
Treatment
Initially, tennis elbow is treated conservatively. The patient is instructed to rest and stop any activity that may aggravate the pain. In addition to rest, the patient is instructed to apply ice to the outside of the elbow to decrease swelling and pain. Finally, the patient is usually instructed to take an anti-inflammatory medication, such as ibuprofen, to decrease inflammation. Symptoms should resolve after 4-6 weeks of conservative treatment.
If conservative therapy fails to resolve the problem within six months, surgery may be necessary. The surgery involves debridement, or removal of damaged tendon tissue. A healthy portion of the tendon is then re-attached to the elbow. Following surgery, physical therapy is prescribed, with an anticipated total recovery time of four to six months.
