Tennis Elbow: Diagnosis and Treatment

Long Island Tennis Magazine By: Alfred F. Faust, M.D.

Lateral epicondylitis, better known around the courts as tennis elbow, is a common cause of pain on the outside of the elbow. There is a wide range of dysfunction, from purely an annoyance with your forehand, to disabling all aspects of life. Men and women are equally affected and usually have symptoms in their dominant extremity. Although most do not recall a specific injury, it is usually the result of over exertion and repetitive motion.

While the name implies otherwise, you don’t have to play tennis to suffer from tennis elbow. It is usually the result of repetitive wrist extension, and alternating forearm rotation that can occur from a weekend of matches, but just as easily from a day in the garden or strenuous workout. The groups of muscles responsible for these motions originate from the bone on the outside of the elbow known as the lateral epicondyle. A microinjury can occur and the resulting inflammation becomes painful. Most often, the body is able to recover on its own but with lateral epicondylitis, repetitive injury and failed healing attempts leads to a dull ache that becomes sharp and is exacerbated with activity.

Tennis elbow is symptomatic with any motion that involves wrist extension or passive wrist flexion with an extended elbow. Most complain of pain with simple tasks, such as opening a door or the inability to hold a cup of coffee. When one finds themselves in this predicament, it is safe to start a home treatment regimen.

The first step to recovery is rest. By resting, the body is able to heal the injury without repeated damage. Second, one should try to avoid all activities that elicit pain. This entails trying to use the non-affected extremity more frequently or picking up objects with your palm facing up, rather than down, in an attempt to not use your wrist and finger extensor muscles. Third, is a home exercise program which should start with stretching. Wrist stretching should first be done with the elbow bent. Once this is pain-free, progress to stretching with the elbow straight. When one is able to fully stretch without pain, progress to a light forearm-strengthening program. In addition, over the counter anti-inflammatory medicines and compression wraps can be helpful but their benefits are mixed.

When these home remedies fail, it is time to seek professional guidance from an orthopedist. The non-operative treatment options consist of formal physical therapy, prescription anti-inflammatory pills or creams, injections such as cortisone or Platelet Rich Plasma (PRP) and bracing. After these have been extensively exhausted, either arthroscopic or open surgery is a good option that provides relief to most.

The good news is that up to 90 percent of individuals who suffer from tennis elbow improve without surgery. While it can take up to a year to fully improve, with patience and adherence to a treatment plan, one can avoid surgery and most importantly, return to pain-free activities and tennis.

Related Link: Kenneth Kearns, M.D. article on Tennis Elbow: Diagnosis and Treatment