Tennis elbow
Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral; Tendonitis - elbow
Tennis elbow is soreness or pain on the outside (lateral) side of the upper arm near the elbow.
This photograph shows the arm bones at the point of articulation (the joint area) between the bone of the upper arm (humerus) and the two bones of the lower arm (radius and ulna).
Causes
The part of the muscle that attaches to a bone is called a tendon. Some of the muscles in your forearm attach to the bone on the outside of your elbow.
When you use these muscles over and over again, small tears may develop in the tendon. Over time, the tendon cannot heal, and this leads to irritation and pain where the tendon is attached to the bone.
This injury is common in people who play a lot of tennis or other racket sports, hence the name "tennis elbow." Backhand is the most common stroke to cause symptoms.
But any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to this condition. Painters, plumbers, construction workers, cooks, and butchers are all more likely to develop tennis elbow.
This condition may also be due to repetitive typing on the computer keyboard and mouse use.
People between 35 to 54 years old are commonly affected.
Sometimes, there is no known cause of tennis elbow.
I'm Dr. Alan Greene and let's talk for a moment about tennis elbow. Tennis elbow is a kind of tendonitis. It's an inflammation and injury to the tendons usually on the outside of the elbow. Tendons are those fibrous bands that connect the muscle into the bone. When those tendons get damaged, as they often can in racquet sports or also in baseball, sometimes over using a screwdriver, a lot of ways you can do it, we typically call it tennis elbow or tendonitis. How do you prevent it? When you are playing tennis one of the most important things is to avoid putting too much stress on that tendon on the outside of the elbow. The problem usually comes with your backhand. So if you do a two-handed backhand, you can greatly reduce the stress. You can also reduce the stress by using a racquet that has the right size grip for your hand. Don't play with somebody else's racquet very often. And make sure the strings are not over tightened. It puts too much stress when the ball hits suddenly with over tightened strings. If you have a tendency to get tennis elbow, it could also be very useful immediately after playing to ice the elbow and take some ibuprofen to prevent swelling and inflammation. Now, if you do develop tennis elbow how do you treat it? It comes down to a combination of rest, ice, compression, and elevation. In terms of rest, you want to completely rest your elbow for at least a couple of days and really for as long as it is still sore. In terms of ice that first day, ice very frequently. It's great even every 15 minutes to have an ice pack on there briefly and for the next couple of days, at least every 3 or 4 hours if you can. It will help speed the healing. Wearing a bandage on there to help support the elbow is good. It can also be good when you are playing tennis to help prevent tennis elbow. The wrap on there can help support the elbow and keep it warm and make it less likely to injure. And finally when you are having the severe pain at the beginning especially, keeping your elbow elevated above your heart can help as well and hopefully this will get you back out and physically active again very quickly.
Symptoms
Symptoms can include any of the following:
- Elbow pain that gets worse over time
- Pain that radiates from the outside of the elbow to the forearm and back of the hand when grasping or twisting
- Weak grip
Exams and Tests
Your health care provider will examine you and ask about your symptoms. The exam may show:
- Pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow
- Pain near the elbow when the wrist is bent backward against resistance
An MRI may be done to confirm the diagnosis.
Treatment
The first step is to rest your arm for 2 or 3 weeks and avoid or modify the activity that causes your symptoms. You may also want to:
- Put ice on the outside of your elbow 2 or 3 times a day.
- Take NSAIDs, such as ibuprofen, naproxen, or aspirin.
If your tennis elbow is due to sports activity, you may want to:
- Ask your provider about any changes you can make to your technique.
- Check the sports equipment you are using to see if any changes may help. If you play tennis, changing the grip size of the racket may help.
- Think about how often you play, and whether you should cut back or cross train.
If your symptoms are related to working on a computer, ask your manager about changing your workstation or your chair, desk, and computer setup. For example, a wrist support or a roller mouse may help.
A physical therapist can show you exercises to stretch and strengthen the muscles of your forearm.
You can buy a special brace (counter force brace) for tennis elbow at most drugstores. It wraps around the upper part of your forearm and takes some of the pressure off the muscles.
Your provider may also inject cortisone and a numbing medicine around the area where the tendon attaches to the bone. This may help decrease the swelling and pain.
If the pain continues after rest and treatment, surgery may be recommended. Talk with your orthopedic surgeon about the risks and whether surgery might help.
Outlook (Prognosis)
Most elbow pain gets better without surgery. But most people who have surgery have full use of their forearm and elbow afterwards.
When to Contact a Medical Professional
Contact your provider for an appointment if:
- This is the first time you have had these symptoms
- Home treatment does not relieve the symptoms
References
Adams JE, Steinmann SP. Elbow tendinopathies and tendon ruptures. In: Wolfe SW, Pederson WC, Kozin SH, Cohen MS, eds. Green's Operative Hand Surgery. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 25.
Biundo JJ. Bursitis, tendinitis, and other periarticular disorders and sports medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 247.
Miller RH, Azar FM, Throckmorton TW. Shoulder and elbow injuries. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 46.
Version Info
Last reviewed on: 9/20/2022
Reviewed by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
