Lateral epicondylitis, commonly known as tennis elbow, is an overuse injury caused by overloading the tendons on the outside of the elbow, leading to inflammation and pain.
Despite its name, this condition affects far more than just tennis players. The condition develops when repetitive motions of the elbow, wrist, or forearm place excessive stress on the tendons that attach to the lateral epicondyle (the bony prominence on the outside of your elbow).
Causes
The primary cause of tennis elbow is repetitive stress and overuse of the forearm muscles and tendons, particularly those involved in gripping and wrist extension. When these muscles are overworked, tiny tears develop in the tendons where they attach to the bone, leading to pain and inflammation.
Common activities associated with tennis elbow include:
- Racquet sports (tennis, squash, badminton)
- Weightlifting and resistance training
- Manual labor requiring repetitive arm movements
- Computer work and prolonged typing
- Activities requiring sustained gripping (painting, carpentry, cooking)
- Playing musical instruments
This repetitive, continuous strain results in inflammation and microscopic tears in the tendon, causing the characteristic pain and dysfunction.
Symptoms
The hallmark symptoms of tennis elbow include:
- Pain with resisted wrist extension – particularly noticeable when lifting objects with your palm facing down
- Pain during gripping activities – such as shaking hands, turning doorknobs, or holding a coffee cup
- Decreased grip strength – you may notice difficulty opening jars or carrying bags
- Tenderness to touch over the outside part of the elbow and upper forearm
- Morning stiffness that improves with gentle movement
- Burning sensation along the outside of the forearm
Pain typically starts gradually and worsens over time, especially with continued activity.
Risk Factors
Several factors can increase your likelihood of developing tennis elbow:
Activity-related factors:
- Repetitive use involving forceful wrist and arm movements
- Poor technique in sports or work activities
- Inadequate rest between activities
Equipment-related factors:
- Heavy racquet or tools
- Incorrect grip size
- High string tension in racquet sports
Personal factors:
- Age (most common between 40-60 years, though it can affect anyone)
- Occupation involving repetitive arm motions or heavy tool use
- Previous elbow injuries
- Poor overall conditioning
Diagnosis
A healthcare provider can usually diagnose tennis elbow based on your medical history and a thorough physical examination. During the exam, your doctor will assess your pain response to specific movements and palpate the affected area.
Imaging studies may include:
- X-rays to rule out arthritis or bone abnormalities
- Diagnostic ultrasound to evaluate tendon integrity and detect tears
- MRI in cases where symptoms don’t improve with treatment or when surgical planning is needed
The diagnosis is often confirmed through specific physical tests, such as the “coffee cup test” (pain when lifting a cup with your arm extended) or resisted wrist extension while the elbow is straight.
Treatment Options
Treatment for tennis elbow typically follows a progressive approach, starting with conservative measures:
Initial Treatment (First 2-6 weeks):
- Rest from aggravating activities
- Ice application for 15-20 minutes several times daily
- Over-the-counter NSAIDs (ibuprofen, naproxen) for pain and inflammation
- Activity modification to avoid repetitive stress
Progressive Treatment:
- Physical therapy focusing on stretching, strengthening, and proper technique
- Tennis elbow brace or strap to redistribute forces away from the injured tendon
- Ergonomic modifications to your workplace or sports equipment
Advanced Treatment Options:
- Corticosteroid injections for significant inflammation (used judiciously)
- Platelet-rich plasma (PRP) therapy to promote healing
- Prolotherapy to strengthen tendon attachments
- Extracorporeal shock wave therapy in select cases
Surgical Intervention: Surgery is rarely needed and typically considered only after 6-12 months of conservative treatment without significant improvement. Surgical options include tendon repair or release procedures.
Recovery and Prevention
Most patients (85-90%) respond well to conservative treatment within 6-12 months. Key prevention strategies include:
- Proper warm-up before activities
- Gradual increase in activity intensity
- Correct technique and equipment selection
- Regular strengthening exercises for forearm muscles
- Adequate rest between repetitive activities
When to Seek Professional Help
If you’re experiencing symptoms of lateral epicondylitis that don’t improve with rest, ice, and over-the-counter medications after 2-3 weeks, consulting with an orthopedic specialist is recommended. Early intervention can prevent the condition from becoming chronic and help you return to your regular activities as quickly as possible.
Remember, while tennis elbow can be frustrating and persistent, with proper treatment and patience, most people make a full recovery and can return to all their favorite activities without limitations.
Start your recovery journey with me, Dr. Christopher Martin, at New York Bone & Joint Specialists.
