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tennis elbow

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Alternative Names
lateral epicondylitis, elbow tendinitis or tendinosis

Tennis elbow is the name for a certain pain on the outside of the elbow. The pain occurs at the bony lump on the outside of the elbow, just above the joint. People who have never played tennis may develop this condition.

What is going on in the body?
Sudden or repeated stress can cause tiny tears in certain muscles and ligaments at the point where they attach to the outside part of the elbow. These are the muscles that straighten the wrist and fingers when they are bent. These muscles also rotate the forearm so that the palm faces up. Tennis elbow causes pain when these muscles are used, or when the outside area of the elbow is bumped.

What are the signs and symptoms of the condition?
The main symptom is pain on the outside of the elbow when the person uses the muscles that straighten the wrist and fingers. Some people complain of pain throughout the lower arm. Pain can also occur when lifting anything, even a lightweight cup, with the palm facing down. The outside of the elbow is usually tender to the touch. Grabbing or twisting movements of the arm are commonly painful. When the wrist or fingers are straightened against resistance or a tight fist is made, pain may occur. There may be some swelling over the outside of the elbow, but this is unusual. The elbow should have its full range of motion.

What are the causes and risks of the condition?
Tennis elbow can be caused by a sudden tension on the muscle or ligament where it attaches to the outside of the elbow. Often this happens during a backhand stroke in racket sports, especially if the stroke technique is poor. Another cause is overuse of the muscles in a repetitive way. Examples of this are prolonged use of a screwdriver or typing.

What can be done to prevent the condition?
Tennis players can avoid tennis elbow by improving their backhand stroke technique. Stretching before a game and exercises to strengthen the muscles can help prevent injuries. Computer workstations should be set up so that the wrists and fingers are well supported while typing.

How is the condition diagnosed?
The history and physical examination are often enough for a doctor to make the diagnosis. People often mention an activity that strains the involved muscles, such as tennis. The outside of the elbow is tender, and straightening the wrist or fingers against resistance causes pain. X-rays are usually normal. However, these may be ordered in some cases to make sure nothing more serious is present.

What are the long-term effects of the condition?
Long-term effects are related to pain and difficulty in straightening the wrist. This may reduce the ability of people to play tennis or engage in other activities.

What are the treatments for the condition?
Tennis elbow often goes away when the activity that caused it is stopped. It may help to lessen the frequency or intensity of the activity. Taking periodic breaks in the action may also help. Resting the elbow and using ice on it can speed recovery. Physiotherapy consists of stretching and strengthening the muscles that straighten the wrist and fingers. Non-steroidal anti-inflammatory drugs (NSAIDs) may be given for pain. Injections of cortisone may also be used to relieve the pain. A tennis elbow band may be advised. This can be worn around the upper forearm to help stop the muscle forces from being carried up to the elbow. Rarely, an operation on the elbow is needed when other treatments do not work.

What are the side effects of the treatments?
NSAIDs, especially if taken for a long time, can affect the stomach, kidneys, blood or liver. cortisone injections carry a very small risk of causing infection. cortisone injections may also weaken the tissues if used too often or cause the skin over the elbow to become pink, shiny, and thin.

If surgery is performed, there is a risk of bleeding, infection, and damage to the nearby tissues. For example, nerve damage may rarely occur. This could cause numbness in part of the arm.

What happens after treatment for the condition?
People are usually advised to slowly increase activities. Many people have a full recovery and can return to their normal activities. Regular strengthening or stretching exercises may help prevent tennis elbow from returning. Reducing the intensity of the activity that caused the injury may be advised.

How is the condition monitored?
Tennis elbow is monitored by the affected person, who can notice the comfort level during physical activity.

Author: John A.K. Davies, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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