Tennis Elbow: What It Is, Symptoms, Diagnosis, and Treatment

Tennis elbow refers to pain that occurs where the tendons of the forearm muscles attach to the bone on the outer side of the elbow.

Tennis elbow refers to pain that occurs where the tendons of the forearm muscles attach to the bone on the outer side of the elbow. The pain may stem from small tears in the tendon. Additionally, the pain can radiate to the forearm and wrist. Resting and using medications prescribed by a doctor can help reduce symptoms. However, to make an accurate diagnosis, the doctor may request various tests. Based on this, the doctor may recommend the appropriate treatment or suggest that the patient exercises under the supervision of a physiotherapist.

What is Tennis Elbow (Lateral Epicondylitis)?

Tennis elbow occurs when the tendons that connect muscles to the bones become overloaded. It is characterized by tears or swelling in the tendons that attach the forearm muscles to the bone in the upper arm. The inflammation resulting from tennis elbow develops due to deformity in the arm caused by overuse. It is named this way because it typically affects tennis players who grip their rackets too tightly and experience arm pain as a result. Tennis elbow causes pain around the outer bony part of the elbow and extends into the forearm. Medically, it is also known as lateral epicondylitis or lateral epicondylopathy. However, tennis elbow can occur in anyone who uses their arms frequently. When pain is present on the outer side of the elbow, a doctor may suspect tennis elbow, which arises from the repetitive use of the muscles around the elbow during movement. Stopping the activity that causes the injury can heal tennis elbow without serious treatments. Tennis elbow is often an overuse injury caused by strain from excessive loading and repetitive tasks involving gripping and wrist extension. Risk factors include:

  • Smoking
  • Obesity
  • Repetitive movements for more than 2 hours a day
  • Intense activity

What Are the Symptoms of Tennis Elbow?

Tennis elbow is a painful condition that arises from excessive use of the arm. The pain can subside quickly or worsen over time. As the pain progresses, it can make working or engaging in physical activity difficult. The condition can also affect grip strength, making it challenging to grasp objects. Tennis elbow can cause pain in the outer part of the elbow and the upper part of the forearm, which may become tender to the touch. Specific movements, such as shaking hands or turning a doorknob, can become very painful. Pressing on the outside of the elbow can further exacerbate the pain. Symptoms of tennis elbow include:

  • Burning and pain that can extend from the elbow to the wrist
  • Pain when twisting or bending the arm
  • Stiffness and pain when extending the arm
  • Swelling in the elbow joint
  • Weakness in gripping with the hand

How is Tennis Elbow Diagnosed?

When a person visits a healthcare facility due to arm pain, the doctor will conduct a physical examination to check for pain, swelling, and stiffness in the elbow joint. The physician may also ask questions about activities that could be causing the pain. To make a diagnosis, one or more tests may be conducted. Conditions such as arthritis can cause pain similar to tennis elbow. To rule out issues like arthritis or fractures that may be causing tennis elbow symptoms, X-rays, ultrasounds, magnetic resonance imaging (MRI), or computed tomography (CT) scans may be performed. Electromyography (EMG) can be used to assess muscle and nerve tissues. If the doctor suspects that the symptoms may be related to a neck problem, they may request an MRI. This helps the doctor determine if there is a possible herniated disk or arthritis in the neck.

Who Can Experience Tennis Elbow?

Repetitive arm movements can lead to fatigue and damage to the forearm muscles. A single tendon connects the muscle in the arm to a bony prominence on the outer side of the elbow. As the muscle in the arm becomes fatigued due to overuse, the load on the tendon increases. This overload can result in inflammation and pain known as tendinitis. Activities such as playing tennis or gardening, which involve extensive use of the wrist and forearm, can lead to tennis elbow pain. Professions that involve repetitive wrist and forearm movements, such as butchering, carpentry, and plumbing, can also contribute to this issue. Individuals at risk for developing tennis elbow include:

  • Tennis, squash, racquetball, and baseball players
  • Assembly line workers
  • Auto mechanics
  • Carpenters
  • Cleaners
  • Painters
  • Plumbers

How is Tennis Elbow Treated?

When serious injuries do not occur, tennis elbow can often heal on its own with minimal treatment. There are non-surgical and minimally invasive treatment options available for tennis elbow. Particularly, it may be necessary to rest the tendons and stop or reduce activities for a few weeks. Additionally, a treatment option known as PRP (platelet-rich plasma) injections may be considered. In more advanced cases, surgical options are available, where damaged tissue is replaced with healthy tendon and muscle from a different part of the body. After developing tennis elbow, it may also be recommended to use a brace to prevent the recurrence of symptoms. Pain relief medications may also be prescribed to alleviate pain. Tennis elbow is a condition that should not be treated independently by the individual. A treatment plan should be determined under the supervision of a doctor.

What Exercises are Recommended for Tennis Elbow?

In addition to clinical treatments, exercise therapy may include specific prescribed exercises designed for therapeutic purposes. Exercises conducted under the supervision of a doctor can help restore normal muscle function or reduce pain caused by injuries. These exercises should always be performed under medical supervision, and the recommended exercises should be followed. Generally, exercises that can help with tennis elbow include:

  • Stretching Exercises: Stretching exercises are often performed before physical activities throughout the day. After recovery, stretching exercises can be incorporated as part of warming up for activities that involve gripping, such as gardening, tennis, and golf. These movements are usually performed by pulling the hand toward the body until a stretch is felt on the outer side of the forearm, with the palm facing downward after straightening the arm.
  • Wrist Extension: Progressive wrist extension and strengthening exercises can be performed with dumbbells. If there is no increase in pain, the repetitions can be increased every few days. To perform the exercise, the elbow is bent at 90 degrees, and the forearm is supported on a table with the wrist hanging off the edge. The arm is moved using a dumbbell.
  • Wrist Flexion: This exercise should be performed progressively, and when completed without increased pain, the weight can be increased. The arm is raised and lowered with a dumbbell for several repetitions.

How to Prevent Tennis Elbow?

Various lifestyle changes can help reduce the risk of developing tennis elbow for those at risk. Here are some strategies to prevent tennis elbow:

  • Stop activities that cause pain or perform them with a different activity that does not cause pain.
  • Avoid using the wrist and elbow more than the rest of the arm. Additionally, distribute the load across larger muscles in the shoulder.
  • If participating in sports involving repetitive arm movements, such as tennis or baseball, consider changing playing techniques.
  • Properly warm up and stretch the arm muscles before starting a sport that involves repetitive arm movements.
  • Use lighter tools or rackets to avoid putting extra pressure on the tendons.
  • Consider wearing a brace while using the arm to prevent further damage to the tendons during activities.
  • Engage in muscle-strengthening exercises under the supervision of a physiotherapist and doctor to increase the strength of the forearm muscles.
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