Tennis Elbow

You must be hearing this term quite frequently. Also known as 'lateral epicondylitis', tennis elbow is a painful condition that affects the outer aspect of the elbow. Unlike the name suggests, it can affect any individual and not just tennis players.

It involves pain and internal swelling (inflammation) over the elbow and results from overuse or repetitive activities involving the extensor muscles of the forearm and wrist.

Let’s explore some details, such as causes, symptoms, diagnosis, treatment options, and preventive strategies, to help you understand and manage this common problem effectively.

Understanding Tennis Elbow: A Comprehensive Guide

Tennis elbow is an inflammation or, rarely, an injury of the extensor carpi radialis brevis (ECRB) muscle of the forearm. This occurs at the point where it originates from a bony prominence on the outer aspect of the elbow called the lateral epicondyle.

Repeated movements of the wrist and hand, involving tight gripping and twisting (e.g., squeezing or wringing of clothes, sweeping), put excessive stress on the ECRB tendon. This leads to inflammation, degeneration, and microtears. The result is constant pain and tenderness on the outer side of the elbow that intensifies with activity.

Who Can Develop Tennis Elbow?

Although tennis players are at an increased risk, anyone who engages in repetitive wrist movements may develop tennis elbow. Common risk groups include:

• Manual labourers: plumbers, carpenters, painters

• Office workers: repetitive typing or mouse use

• Athletes: Tennis, squash, badminton, and golfers

• Home makers: doing activities like sweeping, lifting weights, wringing clothes

  
  

It commonly affects individuals between 30 and 50 years, but it can occur at any age.

Causes of Tennis Elbow

The primary cause is overuse of the forearm extensor muscles, mainly due to:

• Repetitive wrist extension or gripping activities

• Poor technique or weak shoulder muscles in sports like tennis or squash

• Inappropriate equipment (e.g., heavy racquet or tight strings)

• Direct trauma to the elbow

  
  

Repetitive stress on the tendon leads to tendinopathy. This initially involves inflammation (tendinitis) and eventually progresses to degeneration (tendinosis). In chronic and recurrent cases, microtears can be observed.

Recognizing the Symptoms

The prominent symptoms include:

• Sharp pain over the outer aspect of the elbow (lateral epicondyle)

• Pain radiating along the forearm

• Weak grip strength due to pain

• Discomfort when lifting weights, turning a doorknob, or using a computer mouse

• Symptoms worsen with wrist extension

  
  

The pain may start as mild and worsen over weeks to months, especially with continued activity.

Diagnosis of Tennis Elbow

Diagnosis of tennis elbow is primarily clinical. An orthopaedic surgeon takes a thorough history and performs a physical examination. Key diagnostic manoeuvres include:

• Tenderness just distal to the lateral epicondyle

• Pain with resisted wrist extension with the elbow extended (Cozen’s test)

• Pain on passive wrist flexion with the elbow extended

  
  

Imaging is not routinely necessary but may be helpful in chronic cases:

• X-ray: to rule out other bony pathologies

• Ultrasound: shows tendon thickening (tendinosis)

• MRI: helpful to determine tendon quality and diagnose microtears

  
  

Treatment Options for Tennis Elbow

A. Conservative Management

Most cases resolve with non-surgical management. The timeline for complete recovery may vary. It includes:

• Rest: Avoid painful activities

• Cryotherapy: Apply ice packs locally to reduce inflammation

• Bracing: Counterforce elbow straps can reduce strain on the tendons

• Medications: NSAIDs help reduce pain and inflammation early in the course

• Physical therapy: plays a crucial role in recovery

1. Stretching the extensor compartment muscles

2. Strengthening shoulder & peri-scapular muscles (especially external rotators)

3. Ultrasound therapy

• Activity modification: Ergonomic adjustments at work or in sports

  
  

B. Injections

• Corticosteroid: provides short-term relief. Repeated injections are not recommended due to the risk of tendon weakening and tears.

• Platelet-Rich Plasma (PRP): Emerging evidence suggests PRP injections can promote healing by releasing various growth factors.

  
  

C. Shockwave Therapy

Extracorporeal Shock Wave Therapy (ESWT) can stimulate healing in chronic cases by increasing blood flow and metabolic activity in the tendon area.

D. Surgical Treatment

Surgery is quite rare and considered only after 6 to 9 months of failed conservative treatment. The goal is to remove degenerated tendon tissue, repair the healthy tissue, and stimulate healing. Types of procedures include:

• Open release of the ECRB tendon

• Arthroscopic debridement

  
  

Post-operative recovery involves short-term immobilisation, followed by a structured rehabilitation program.

Recovery Timeline

Recovery depends on the severity of the condition and compliance with treatment:

• Mild cases resolve in 6–12 weeks with rest and physiotherapy

• Moderate to severe cases may take 3 to 6 months

• Post-surgery, patients can return to heavy activities within 4 to 6 months, depending on progress

  
  

Adherence to rehabilitation and exercise regimes is crucial for achieving long-term relief and preventing recurrence.

Preventing Tennis Elbow

Yes, it is possible to prevent tennis elbow! Prevention involves minimising repetitive strain and optimising biomechanics.

• Ergonomics: Use proper workstation setup and posture

• Technique correction: Seek professional guidance by a coach in racquet sports

• Strengthening exercises: Focus on arm and shoulder muscles

• Stretching: Perform stretches for wrist extensors

• Equipment adjustments: Use lighter racquets, proper grip size, and loosen tight strings

• Warm-up and cool-down: Especially before intense arm activity

  
  

Conclusion

Tennis elbow, though often mild, can significantly interfere with daily life and activities if left untreated. With early diagnosis and conservative management, most individuals recover fully without the need for surgery. If you’re experiencing persistent elbow pain, get it evaluated as early treatment can make all the difference.

For more information on managing elbow pain, consider visiting this resource.