Mayuri Bhakta, FNP-BC
About 50% of tennis players will suffer from tennis elbow at some point. However, only about 5% of all tennis elbow injuries happen to tennis players. So, who are the other 95% and why? Lateral epicondylitis, commonly called tennis elbow, is caused by repetitive extension of your wrist and arm. The repeated extension causes irritation to the tendons that attach to the outside of the elbow and to the structures around those tendons.
People who develop tennis elbow often engage in activities or have occupations where this kind of repetitive extension is frequent. Examples are:
- Tennis, squash, and badminton players. These players are at higher risk to develop tennis elbow if they have improper hitting techniques, improper training, and/or improper equipment.
- Painters, plumbers, carpenters, butchers, cooks, dentists, and musicians.
- Anyone who performs repetitive movements involving extension of the wrist or hand for at least two hours a day, which can include anyone sitting at a computer and using a mouse.
In addition, people between the ages 30-50, smokers, and who are obese are at greater risk for developing tennis elbow.
What are the symptoms of tennis elbow?
Symptoms of tennis elbow can begin as a mild pain that usually starts on the outside of your elbow and may progress with worsening pain that radiates into your forearm and wrist. You may experience pain and weakness of the affected arm and wrist which can impair your ability to perform daily activities without feeling discomfort. You may notice pain when gripping an object or shaking someone’s hand. It may become difficult for you to turn a doorknob or hold a cup. The pain may also worsen when playing sports, such as tennis, or when performing repetitive tasks at work.
How is tennis elbow diagnosed?
Your healthcare provider will take your medical history and perform a physical exam. Your provider will ask you to perform certain maneuvers with your arm during the physical exam which will help in the diagnosis. Your provider may be able to diagnose you with tennis elbow based on your history and physical exam alone and may or may not order additional studies such as x-rays.
How is tennis elbow treated?
Tennis elbow can be treated with medications such as NSAIDs (nonsteroidal anti-inflammatories) like Ibuprofen and physical therapy. Your provider may place you in a tennis elbow splint to wear as directed. Based on your physical examination, symptoms, and occupation, your provider may place you on work restrictions to avoid repetitive use and/or heavy lifting, and may recommend avoiding playing sports such as tennis, which can worsen your symptoms.
Your provider may also suggest stretching exercises to help stretch the muscles in the lower arm which may help relieve pain.
If your symptoms do not improve, you may be referred to an orthopedist. The orthopedist may suggest a steroid injection if indicated. If there is still no improvement in symptoms, the orthopedist may order an MRI or ultrasound and may recommend surgery, although this is rare.
Will I ever be able to return to my normal activity after being diagnosed with tennis elbow?
It may take several weeks or months to get back to activities with no pain, but the goal of treatment is to get you back to work and/or back to playing sports without pain. With appropriate diagnosis and treatment, most people return to normal activity without pain in a matter of weeks.
If you develop work-related tennis elbow, you may benefit from an ergonomic evaluation to ensure that you use you proper techniques when performing repetitive tasks. If you are a tennis, squash, or badminton player, you may benefit from instructions on proper technique. You may also be directed to take breaks when performing repetitive movements of the wrist and arm in order to prevent tennis elbow.
American Society for Surgery of the Hand, “Tennis Elbow – Lateral Epicondylitis,” https://www.assh.org/handcare/hand-arm-conditions/tennis-elbow
International Tennis Federation, “Tennis Elbow,” https://www.itftennis.com/scienceandmedicine/injury-clinic/tennis-injuries/tennis-elbow.aspx
Johns Hopkins Medicine, “Lateral Epicondylitis (Tennis Elbow),” https://www.hopkinsmedicine.org/health/conditions-and-diseases/lateral-epicondylitis-tennis-elbow
Mayo Clinic, “Tennis elbow,” February 14, 2019, https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987
Neeru Jayanthi, “Epicondylitis (tennis and golf elbow),” UptoDate, updated October 16, 2018.
Paul Ingraham, “Save Yourself from Tennis Elbow!,” PainScience.com, updated June 1, 2019, https://www.painscience.com/articles/tennis-elbow.php
WebMD, “What is Tennis Elbow?” https://www.webmd.com/pain-management/tennis-elbow#1