Your doctor says you have ‘tennis elbow’… but you have never even picked up a racquet to play?!

How did that happen?

Patients with tennis elbow present with pain at the bony point on the outside of the elbow, particularly when they extend their wrist or fingers. Sometimes the pain can radiate into the forearm or up to the shoulder. Tennis elbow in the medical community is known as ‘lateral epicondylitis’, which simply means inflammation involving the bony prominence on the outside of the elbow.

How does this inflammation get started?

Tennis elbow is nearly always caused by repetitive forceful gripping with the hand. Although seen frequently in tennis players, it is most commonly seen in patients who have never stepped on a tennis court. Instead it is the result of frequent swinging of a hammer, repetitive work on an assembly line, prolonged typing at a poorly positioned keyboard, recurring scanning of items at a checkout line, or even a day spent swinging a golf club.

All of these activities have one thing in common…

– they require repetitive use of the muscles that stabilize the wrist and fingers. And these muscles attach to the arm at the bony prominence located on the outside of the elbow. Inflammation and small tears develop at this point, and pain soon follows.

What can be done for tennis elbow?

The best thing to do is to keep it from developing in the first place. This can be done by recognizing which activities put you at risk, and modifying them to decrease the chances of developing tennis elbow. That may mean using a larger grip on your tennis racquet or using a softer racquet, making your workstation more ergonomic, or incorporating a regimen of stretching and strengthening before starting these activities.

What can be done once the pain has started?

The first step in management is very similar to what is done to prevent it – realize which activities might have aggravated this condition and make changes to those activities to decrease the stress on your forearm muscles. Your healthcare provider can help you determine which activities are troublesome and how you might modify them.

Sometimes such simple changes are not enough, and there remains persistent pain on the outside of the elbow. Additional treatment options include physical therapy focused on stretching and strengthening the forearm muscles, and the use of local modalities such as ultrasound, to decrease inflammation. Anti-inflammatory medications that decrease the inflammation from arthritis and other joint pains also work well on the inflammation associated with tennis elbow. Healthcare providers may also recommend bracing with aggravating activities, which usually means placing a strap around the elbow to decrease the stress the elbow feels and potentially reduce the swelling from inflammation.

When these things fail, your primary care physician may refer you to a specialist. The specialist’s first job is to evaluate you for less common causes of pain around the elbow such as bone and joint diseases. When the diagnosis of lateral epicondylitis is confirmed, they may recommend a steroid injection, which may give tremendous relief. For patients who continue to experience persistent pain despite all of these treatments, particularly those with good but temporary relief with a steroid injection, there are surgical options to remove the inflammation and repair the tendon insertion.

The key to treating tennis elbow is recognize it early and modify aggravating activities. For those that don’t respond to these changes, a referral to a specialist is recommended. And hopefully you’ll be back on the tennis court….or jobsite, in no time!