Tennis Elbow

What is tennis elbow (lateral epicondylitis)?

The extensor tendon plays a crucial role in the development of tennis elbow. This tendon connects the forearm muscles to the outer part of the elbow, allowing for wrist and finger extension. The extensor carpi radialis brevis (ECRB), a key forearm muscle, is particularly susceptible to overuse and damage. When repetitive motions strain these structures, tiny tears can form in the extensor tendon where it attaches to the lateral epicondyle (the bony bump on the outside of the elbow). This damage leads to inflammation and pain, characteristic of tennis elbow. Understanding the anatomy of these structures helps explain why certain movements, especially those involving wrist extension and gripping, can exacerbate the condition.

Tennis elbow (or lateral epicondylitis) is a common overuse injury that causes the outside part of your elbow and forearm to hurt. It’s caused by overuse of the muscles and tendons that attach to your elbow and allow your wrist and fingers to extend.

While it’s called “tennis elbow,” the injury can also be from playing any sport that involves swinging motions, such as other racket sports, golf, and baseball pitching. You can also get it from manual labor, especially painting, carpentry, and plumbing.

With treatment, you can expect to get some relief. However, symptoms can last for as long as two years (even with treatment) and can come back in the future.

Most common symptoms

People with tennis elbow have pain around the outside edge of their elbow. Usually, the pain only affects one arm. Though it can affect both.

The pain is worse when arms are straight and you try to flex your wrists upward (while palms are facing the floor). It can also hurt when you touch or press the outer part of your elbow.

Another way to tell if you have tennis elbow is if it hurts when you hold a heavy book straight in front of you, with your elbows straight and palms facing the floor.

When you have pain on the inner edge of your elbow (with palms toward the floor), you probably have golfer’s elbow, not tennis elbow.

Keep in mind that there can be many different reasons for pain in your elbow. Pay attention to where it hurts, when it hurts, what makes it better, and what you were doing when it started hurting. Share these details with your doctor to help them correctly diagnose you.

Main symptoms

• Pain in the outside part of your elbow
• Pain is worse when you press on it
• Pain improves when arms are bent at the elbow

Tennis elbow causes

Overuse of your wrist, especially with added force or weight, increases your risk. It can happen for a variety of reasons. Tennis elbow is an overuse injury, meaning that it occurs because the forearm muscles are used too much. This leads to inflammation of tendons, which causes pain.

• Cocking your wrist forward or backward as you come into contact with an object (such as a ball).
• Poor form while playing sports, such as not following through on a tennis swing.
• Not keeping your wrist in a neutral position when swinging a racket (your hand should be in a straight line with your forearm).
• Using your wrist in a repetitive way for more than 2 hours a day.
• Using too much weight across your wrist.
• Older age, such as 40 or over, makes you more likely to have tennis elbow.

Next steps

If you have elbow pain for more than a few days, call your primary care physician to schedule an appointment. The doctor will examine your elbow, arm, and wrist. Usually, based on the physical exam alone, they can make the diagnosis of tennis elbow.

Tennis elbow treatment

• Reduce the activity that caused the pain. You may need to stop the activity completely for 6 to 12 weeks to recover. This will help reduce the inflammation and give your tendon a chance to heal.
• Practice stretching exercises. One to try: Rest your forearm on a table with your wrist hanging off slightly so you can move it. Then bend and extend for at least 30 seconds several times a day. You can find more wrist exercises from the American Academy of Orthopaedic Surgeons.
• Go to physical therapy.
• Ice the affected area.

Medications

These medications can reduce pain.

• Acetaminophen (Tylenol): Available over-the-counter. Check with your doctor about how much to take daily. Too much can cause other medical issues, including liver failure and death.
• Anti-inflammatory pain relievers include ibuprofen, naproxen, and meloxicam. Do not take these if you have kidney problems or stomach ulcers. Always drink a lot of water when taking these, and take them with some food.
• Your doctor can give you a cortisone injection in the outside of the elbow where the tendons attach. It’s usually done if physical therapy, rest, and other treatments have not worked after about 6 weeks. The effects can last from 2 to 12 weeks or longer.

Follow up

Follow up with your doctor if your symptoms do not improve after trying the strategies above for 6 to 8 weeks. You may need to see your doctor for repeated steroid injections. Consider meeting with an athletic trainer (if it’s a sports injury) to get some tips about technique and form.

Prevention

Proper form in sports can prevent tennis elbow. Up to 90% of affected people can recover by relearning proper form.

• Keep your wrist in a neutral position (in a straight line with your forearm).
• Avoid repetitive motions that require extending the wrist.
• Stretch your muscles around your wrist.

For tennis players:

• Always follow through and lead with your elbow.
• Try to keep your wrist in a neutral position.
• Consider using less topspin.
• Two-handed backhand may have a lower risk than a one-handed backhand.
• Do not use your wrist to generate force. Force should come from your chest, back, and arm muscles.