Tennis elbow

Georgios Panagopoulos MD | Orthopaedic Surgeon

What is tennis elbow?

Tennis elbow, or lateral epicondylitis, is a painful condition that occurs when the tendons at your elbow are overloaded by repetitive motion of your arm and wrist. Despite the name, tennis players are not the only ones who get it. People whose job requires repetitive motion at the elbow, such as carpenters, plumbers, butchers, painters, as well as those who perform racquet sports are particularly susceptible. Your forearm muscles attach through a tendinous insertion on a bony bump at your elbow. That’s where the pain of tennis elbow primarily occurs. Pain can also spread into your forearm and wrist. Rest, over-the-counter painkillers and stretching exercises help relieve tennis elbow in the overwhelming majority of cases. If conservative treatment fails or if symptoms are very disabling, your doctor might suggest surgery, either keyhole or mini-open.

What causes tennis elbow?

Tennis elbow is an overuse syndrome, affecting the forearm muscles that you use to raise your wrist and fingers. Repetitive motion leads to microtears in the tendinous insertion of these muscle to the elbow.

Common arm movements potentially implicated with the development of tennis elbow include: using plumbing tools, painting, driving screws, cutting cooking ingredients, such as meat, prolonged use of a computer mouse, playing tennis, especially repetitive use of a backhand stroke with poor technique. With regards to age, most patients with tennis elbow are in their 30s to 50s. Professions at risk include plumbers, carpenters, butchers, painters and cooks. Other professions include gardeners and bricklayers, dentists, manicurists and musicians. Using hand tools repeatedly (gardening shears, screwdriver or scissors) and using tools while decorating, plumbing or bricklaying have been implicated. Tennis elbow is also common in people who play racquet sports (tennis, badminton or squash) or sports that involve throwing (javelin or discus). Fencers, bowlers and baseball players are also susceptible. Certain medications, such as fluoroquinolone antibiotics have been also implicated.   

What are the symptoms?

Symptoms of tennis elbow usually include pain on the outside of the elbow that radiates to the forearm & wrist. Pain and weakness are common with certain everyday activities, such as:

• Turning a doorknob
• Using a screwdriver
• Holding a cup of coffee, or even shaking hands.

Symptoms usually start insidiously and get worse with time. 

What’s the difference between tennis elbow and golfer’s elbow?

Golfer’s elbow, or medial epicondylitis, is a similar condition that occurs on the inside rather than the outside of the elbow. Contrary to what the name suggests, golfer’s elbow is not only limited to golf players. Racket sports (tennis, squash), throwing sports (javelin, archery, baseball), weight training, as well as certain occupations (construction, carpentry, plumbing) are common culprits. Natural history and treatment are otherwise similar to tennis elbow.

Diagnosis

History and physical exam usually provide enough information for your doctor to make a diagnosis of tennis elbow. However, if your doctor suspects that something else may be causing your symptoms, they may suggest X-rays or other types of imaging, such as an MRI scan.

Conservative treatment

Over 80% of patients will have success with non-surgical treatment. As with many sports-related injuries, rest, immobilization, compression and elevation (RICE) might do the job. Over-the-counter medication, such as ibuprofen or other NSAIDS may play a role in getting you better. Physical therapy can also help strengthen the muscles around the elbow and decrease pain. A physical therapist can teach you exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm. In some cases, a splint or brace will be recommended. If the above fail to improve your condition, the next step up is the use of injections. Treatment modalities can be summarised as follows:

• Rest & ice therapy
• NSAIDS
• Physiotherapy/home exercise program
• Physiotherapy/home exercise program
• Splint, especially at night to keep the finger extended for up to six weeks.
• Dry needling – after application of local anaesthetic, a small needle pierces the damaged tendon in many places (peppering).

All the above modalities are very effective and provide prolonged relief in the vast majority of patients. Appropriate physiotherapy, home exercises (Theraband stretches), potentially with the addition of an injection, are usually more than enough.

Surgical Treatment

However, if symptoms fail to improve after 6-12 months of the above therapies, or if your symptoms are very debilitating, your doctor may recommend surgery. Surgery may include either arthroscopic or open debridement of the involved tendon. We offer both mini-open and arthroscopic tennis elbow surgery. Dr Panagopoulos will discuss all options with you during your visit in the office. Either way, this is a day procedure and the patient typically returns home a few hours after the surgery with a small dressing and a sling for comfort.

About 90% of patients with tennis elbow get better with conservative treatment and can fully resume activities. It may take 6-12 months for symptoms to go away. A small number of people need surgery. Between 80-90% of people who get surgery see their symptoms improve within a year.

FAQs - Frequently Asked Questions