Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players.
The backhand swing in tennis can strain the muscles and tendons of the elbow in a way that leads to tennis elbow. But many other types of repetitive activities can also lead to tennis elbow–painting with a brush or roller, running a chain saw, and using many types of hand tools. Any activities that repeatedly stress the same forearm muscles can cause symptoms of tennis elbow.
Tennis elbow causes pain that starts on the outside bump of the elbow, the lateral epicondyle. The forearm muscles that bend the wrist back (the extensors) attach on the lateral epicondyle and are connected by a single tendon. Tendons connect muscles to bone.
Tendons are made up of strands of a material called collagen. The collagen strands are lined up in bundles next to each other.
When you bend your wrist back or grip with your hand, the wrist extensor muscles contract. The contracting muscles pull on the extensor tendon. The forces that pull on these tendons can build when you grip things, hit a tennis ball in a backhand swing in tennis, or do other similar actions.
Overuse of the muscles and tendons of the forearm and elbow are the most common reason people develop tennis elbow. Repeating some types of activities over and over again can put too much strain on the elbow tendons. These activities are not necessarily high-level sports competition. Hammering nails, picking up heavy buckets, or pruning shrubs can all cause the pain of tennis elbow.
The problem is within the cells of the tendon. Doctors call this condition tendinosis. In tendinosis, wear and tear is thought to lead to tissue degeneration. A degenerated tendon usually has an abnormal arrangement of collagen fibers.
The body produces a type of cells called fibroblasts. When this happens, the collagen loses its strength. It becomes fragile and can break or be easily injured. Each time the collagen breaks down, the body responds by forming scar tissue in the tendon. Eventually, the tendon becomes thickened from extra scar tissue.
The forearm tendon develops small tears with too much activity. The tears try to heal, but constant strain and overuse keep re-injuring the tendon. After a while, the tendons stop trying to heal. The scar tissue never has a chance to fully heal, leaving the injured areas weakened and painful.
The main symptom of tennis elbow is tenderness and pain that starts at the lateral epicondyle of the elbow. The pain may spread down the forearm. It may go as far as the back of the middle and ring fingers. The forearm muscles may also feel tight and sore.
The pain usually gets worse when you bend your wrist backward, turn your palm upward, or hold something with a stiff wrist or straightened elbow. Grasping items also makes the pain worse. Just reaching into the refrigerator to get a carton of milk can cause pain. Sometimes the elbow feels stiff and won’t straighten out completely.
The physical exam is often most helpful in diagnosing tennis elbow. Your doctor may position your wrist and arm so you feel a stretch on the forearm muscles and tendons. This is usually painful with tennis elbow. There are also other tests for wrist and forearm strength that can be used to detect tennis elbow.
When the diagnosis is not clear, your doctor may order other special tests. An MRI scan is a special imaging test that uses magnetic waves to create pictures of the elbow in slices. The MRI scan shows tendons as well as bones.
The key to conservative (nonsurgical) treatment is to keep the collagen from breaking down further. The goal is to help the tendon heal.
If the problem is caused by acute inflammation, anti-inflammatory medications such as ibuprofen may give you some relief. If inflammation doesn’t go away, your doctor may inject the elbow with cortisone. Cortisone is a powerful anti-inflammatory medication.
Doctors commonly have patients with tennis elbow work with a physical or occupational therapist. At first, your therapist will give you tips how to rest your elbow and how to do your activities without putting extra strain on your elbow. Your therapist may apply tape to take some of the load off the elbow muscles and tendons. You may need to wear an elbow strap that wraps around the upper forearm in a way that relieves the pressure on the tendon attachment.
Your therapist may apply ice and electrical stimulation to ease pain and improve healing of the tendon. Electrical stimulation is often used to reduce pain and promote healing. It is a method used to relieve pain in an injured or diseased part of the body. Electrodes applied to the skin deliver low voltage intermittent stimulation to surface nerves in the skin. The transmission of pain signals is blocked and endorphins are released. Endorphins are the body’s natural pain killers.
Electrical stimulation is also known as transcutaneous electrical nerve stimulation (TENS). TENS refers to many types of electrical units that are used to relieve pain. Electrodes are placed on the skin near the injured area and attached to a stimulator by flexible wires. Electrical impulses are then produced to give relief from pain. The battery-operated unit is portable and can be used at home by the patient.
TENS is non-invasive and non-addictive. It has no side effects and can be used to treat acute or chronic pain. Persons who use pacemakers must not use any form of TENS. The electrical impulses may interfere with the pacemaker’s action.
Exercises are used to gradually stretch and strengthen the forearm muscles.
Because tendinosis is often linked to overuse, your therapist will work with you to reduce repeated strains on your elbow. When symptoms come from a particular sport or work activity, your therapist will observe your style and motion with the activity. You may be given tips about how to perform the movement so the elbow is protected. Your therapist can check your sports equipment and work tools and suggest how to alter them to keep your elbow safe.