Tennis Elbow

What is tennis elbow?

• Tennis elbow, also called lateral epicondylitis, is a condition that causes pain in your elbow area. The elbow is a joint where your upper arm bone (humerus) meets your two lower arm bones (radius and ulna). The bones in your elbow joint are held together with ligaments. The muscles that surround your elbow joint are connected to bone by cords of tissue called tendons. There also are blood vessels and nerves found in, and near your elbow joint.
  
  
• When you have tennis elbow, you may not be able to move your elbow or arm like you normally do. The pain from tennis elbow is often felt in the area of your lateral epicondyle. The lateral epicondyle is the bony end of your humerus that you can feel on the outer side of your elbow. The tendon that connects your muscles to your lateral epicondyle is the extensor tendon. The muscles of your lower arm (forearm) are connected from your lateral epicondyle to your wrist. Having your tennis elbow treated may decrease your symptoms such as pain. Treatment may allow you to return to the activities you enjoy, such as sports.

What causes tennis elbow?

The exact cause of tennis elbow is not known. Caregivers believe it is caused by overusing the muscles in your forearm. Fast repeated arm movements can lead to inflammation (swelling) and small tears in your extensor tendon. Overuse of the muscles leading to tennis elbow is common in tennis players and manual labor workers.

What are the signs and symptoms of tennis elbow?

Tennis elbow is more common in people between the ages of 30 to 60. Tennis elbow occurs more often in your dominant (most used) arm. You may have any of the following signs and symptoms:

• Elbow and forearm pain that worsens when moving your wrist, middle finger, or both.
  
  
• Problems holding, lifting, or grabbing an object, such as a coffee cup.
  
  
• Tenderness (pain when touched) on the outer side of your elbow.
  
  
• Swelling, redness, or warmth of the skin on the side of your elbow.
  
  
• Weakness in your wrist or hand.

How is tennis elbow diagnosed?

Your caregiver will ask you about the signs and symptoms you are having. Your caregiver will feel around your elbow to check for painful areas. He also may check the movement of your elbow, wrist, and fingers. Tell your caregiver when certain movements cause you to feel pain. Your caregiver may be able to diagnose your tennis elbow by learning your symptoms. You also may need the following:

• Joint x-ray: This is a picture of the bones and tissues in your joints. Joints are the places in your body where two bones meet. You may be given dye as a shot into your joint before the x-ray. This dye will help your joint show up better on the x-ray. A joint x-ray with dye is called an arthrogram.
  
  
• Ultrasound: An ultrasound is a test that looks inside of your body. Sound waves are used to show pictures of your elbow and forearm tissues on a TV-like screen. An ultrasound may show if you have tears in your tendon or fluid surrounding your elbow joint.
  
  
• Magnetic resonance imaging: This test is also called an MRI. During the MRI, pictures are taken of your elbow. An MRI may be used to check for tears in your elbow ligaments and forearm tendons. An MRI may also show if there is any damage to your elbow joint or arm bones. You will need to lie still during the MRI. Never enter the MRI room with any metal objects. This can cause serious injury.

How is tennis elbow treated?

The goal of treatment is to decrease your pain and improve the movement of your elbow. Ask your caregiver for more information about these and other treatments you may need for tennis elbow:

• Elbow supports: An arm strap, brace, or splint may be put on your elbow to limit your arm movement. Braces and splints work to help decrease pain, and prevent more damage to your tendon.
  
  
• Rest: You may need to rest your injured arm and avoid activities that cause you pain. Resting your arm helps your tendon and forearm muscles heal.
  
  
• Medicines:
  
  
  • Acetaminophen: This medicine can be used to decrease your pain. Taking too much acetaminophen can hurt your liver. Read labels so that you know the active ingredients in each medicine that you take. Talk to your caregiver before taking more than one medicine that contains acetaminophen. Ask your caregiver before taking over-the-counter medicine if you are also taking pain medicine prescribed (ordered) for you.
    
    
  • Nonsteroidal anti-inflammatory medicine: Nonsteroidal anti-inflammatory medicines (NSAIDs) may help decrease pain and inflammation. This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
  
  
• Injection therapy:
  
  
  • Steroid injections: Steroid injections (shots) may be given in your injured elbow to help decrease pain and swelling.
    
    
  • Botulinum toxin type A: Botulinum toxin type A (Botox) may be given as a shot into your elbow to help decrease your pain. Botox shots also may help your muscles and tendons rest and heal.
  
  
• Physical therapy: Your caregiver may have you go to physical therapy. A physical therapist will help you with exercises to stretch and strengthen your tendon. These exercises may also help to decrease your pain. You will need to start slowly and increase your activity as you get stronger. Physical therapy may help you return to your usual activities faster. During physical therapy, you may also have the following:
  
  
  • Massage: A caregiver may massage the deep tissues in your elbow and forearm to improve movement and healing.
    
    
  • Ultrasound: During an ultrasound, a small plastic or metal tool will be moved around your elbow where you have pain. The tool uses heat to reach your deep tissues and decrease your pain. The heat may also decrease any swelling and help heal your tissues.
  
  
• Shock wave therapy: During shock wave therapy, sound waves are directed into the tissues around your elbow. This therapy may help to decrease your pain and improve healing.
  
  
• Surgery: You may need surgery if your symptoms do not improve with other treatments. Surgery may be done to release (cut) the extensor tendon from the lateral epicondyle. Your caregiver may remove any damaged tendon tissue before reattaching the tendon to nearby tissue or bone. Your caregiver may also do surgery to only remove damaged tissue without cutting the tendon away from the bone. Ask your caregiver for more information about surgery to treat your tennis elbow.

What can I do to help decrease the pain from tennis elbow?

• Acupuncture: Acupuncture is a treatment based on a belief that fluids flow through channels in our bodies. Caregivers insert very thin needles just under your skin. This is believed to open the channels, allowing fluids to flow better. This treatment may decrease pain and improve healing. Always see a caregiver for acupuncture. Do not try to give this treatment to yourself.
  
  
• Ice: Ice causes blood vessels to constrict (get small) which helps decrease swelling and pain. Put crushed ice in a plastic bag and cover it with a towel. Put the ice pack on your elbow for 15 to 20 minutes every hour. Use the ice for as long as your caregiver says you should. Do not sleep on the ice pack because you can get frostbite.

What are the risks of tennis elbow?

• You may have an allergic response to the medicines used to treat your tennis elbow. Steroid shots may cause pain, changes in your skin color, and fat loss in the area of the shot. Steroid shots may also weaken your tendon and increase the risk for tendon rupture. Botox shots may cause finger numbness and weakness. Surgery may cause you to have pain, swelling, and bruising. Surgery may also cause nerve damage leading to numbness (loss of feeling) in your elbow or forearm. New bone may form in abnormal areas around your elbow as the area is healing. Even after treatment, you may still have pain and weakness in your elbow, wrist, or hand. With treatment your symptoms may go away and then return again after a period of time.
  
  
• Without treatment your symptoms, such as pain may not go away or get worse. You may have problems using your arm or hand. You may not be able to grab, squeeze, or lift items with your injured hand and arm. It may be hard for you to do your usual daily activities. Talk to your caregiver if you have questions or concerns about your condition, treatment, or care.

Where can I find more information?

Contact the following:

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont , IL 60018-4262
  Phone: 1- 847 - 823-7186
  Web Address: http://www.aaos.org/
  

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

When should I call my caregiver?

Call your caregiver if:

• You have more pain or weakness in your arm, wrist, hand, or fingers.
  
  
• You have new numbness or tingling in your arm, hand, or fingers.

When should I seek immediate help?

Seek immediate help or call 911 if:

• You suddenly have no feeling in your arm, hand, or fingers.
  
  
• You suddenly cannot move your arm, wrist, hand, or fingers.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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