The classic tennis elbow is caused by repeated forceful contractions of wristmuscles located on the outer forearm. The stress created at a common muscleorigin causes microscopic tears leading to inflammation of several structuresof the elbow. These include muscles, tendons, bursa, periosteum, and epicondyle (bony projections on the outside and inside of the elbow, where muscles of the forearm attach to the bone of the upper arm). This overuse injury is common between ages 20-40.
People at risk for tennis elbow are those in occupations that require strenuous or repetitive forearm movement. Such jobs include mechanics or carpentry.Sport activities that require individuals to twist the hand, wrist, and forearm, such as tennis, throwing a ball, bowling, golfing, and skiing, can causetennis elbow. Individuals in poor physical condition, who are exposed to repetitive wrist and forearm movements for long periods of time, may be prone totennis elbow. This condition is also called epicondylitis, lateral epicondylitis, medial epicondylitis, or golfer's elbow, where pain is present at the inside epicondyle. If the condition becomes long-standing and chronic, a decrease in grip strength can develop.
Diagnosis of tennis elbow includes the individual observation and recall of symptoms, a thorough medical history, and physical examination by a physician.Diagnostic testing is usually not necessary unless there may be evidence ofnerve involvement from underlying causes. X rays are usually always negativebecause the condition is primarily soft tissue in nature, in contrast to a bony disorder.
Heat or ice is helpful in relieving tennis elbow pain. Once acute symptoms have subsided, heat treatments are used to increase blood circulation and promote healing. The physician may recommend physical therapy to increase the thermal temperature of the tissues in order to address both pain and inflammation. Occasionally, a tennis elbow splint may be useful to help decrease stress on the elbow throughout daily activities. Exercises become very important to improve flexibility to all forearm muscles, and will aid in decreasing muscleand tendon tightness that has been creating excessive pull at the common attachment of the epicondyle. The physician may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) to reduce inflammation and pain. Injections of cortisone or anesthetics are often used if physical therapy is ineffective. Cortisone reduces inflammation, and anesthetics temporarily relieve pain. Physicians are cautious regarding excessive number of injections as this has recently been found to weaken the tendon's integrity. If conservative methods of treatment fail, surgical release of the tendon at the epicondyle may be a necessary form of treatment. However, surgical intervention is relatively rare.
Massage therapy has been found to be beneficial if symptoms are mild. Massagetechniques are based primarily on increasing circulation to promote efficient reduction of inflammation. acupuncture and acupressure have been used as well. Contrast hydrotherapy (alternating hot and cold water or compresses, 3 minutes hot, 30 seconds cold, repeated 3 times, always ending with cold) applied to the elbow can help bring nutrient-rich blood to the joint and carry awaywaste products. Botanical medicine and homeopathy may also be effective therapies for tennis elbow. For example, cayenne (Capsicum frutescens) ointment or prickly ash (Zanthoxylum americanum) oil applied topically may help to increase blood flow to the affected area and speed healing.
Until symptoms of pain and inflammation subside, activities requiring repetitive wrist and forearm motion should be avoided. Once pain decreases to the point that return to activity can begin, the playing of sports, such as tennis,for long periods should not occur until excellent condition returns. Many times, choosing a different size or type of tennis racquet may help. Frequent rest periods are important despite what the wrist and forearm activity may be.Compliance to a stretching and strengthening program is very important in helping prevent recurring symptoms.