Tennis Elbow (Lateral Epicondylitis)
Tennis elbow, also known as lateral epicondylitis or lateral elbow tendinopathy, is a common cause of pain on the outside of the elbow. It develops when the tendons that connect the forearm muscles to the outside of the elbow are repeatedly stressed or overloaded.
Despite its name, this condition does not only affect tennis players. Repetitive gripping, lifting, wrist extension and forearm activity associated with work, sports, hobbies and everyday activities can place repeated stress on these tendons.
Lateral Epicondylitis often develops gradually rather than following a single injury. Symptoms can range from mild discomfort to persistent pain and weakness that interfere with work, sports and normal daily activities.
What Causes Lateral Epicondylitis?
The elbow is made up of three bones which are the upper arm bone (humerus) and two bones in the forearm (radius and ulna). At the lower end of the humerus are bony prominences called epicondyles. The lateral epicondyle is located on the outside of the elbow.
Muscles in the forearm that extend the wrist and fingers attach near the lateral epicondyle through tendons. One of the tendons commonly associated with tennis elbow is the extensor carpi radialis brevis (ECRB).
Repeated use of the wrist and forearm can place excessive stress on these tendons. Over time, repetitive loading can result in small tendon injuries and degenerative changes that cause pain and reduced function.
Tennis and other racquet sports can contribute to the condition, particularly when repetitive strokes place significant force on the forearm muscles and tendons. However, many people who develop the condition have never played tennis.
Work and recreational activities involving repeated gripping, twisting, lifting or wrist movement can also contribute to lateral epicondylitis. Painters, carpenters, cooks, butchers and people performing other repetitive manual tasks may be at increased risk.
What are Symptoms of Lateral Epicondylitis?
The most common symptom of lateral epicondylitis is pain or tenderness on the outside of the elbow. Symptoms usually develop gradually and may become more noticeable as the affected arm continues to be used.
Symptoms may include:
- Pain or aching on the outside of the elbow
- Tenderness around the lateral epicondyle
- Pain that extends into the forearm
- Weakness in the forearm
- Reduced grip strength
- Pain when gripping or lifting an object
- Pain when extending the wrist
- Discomfort during repetitive hand or wrist movements
Activities as simple as shaking hands, turning a doorknob, carrying a bag, using tools or picking up a cup may become uncomfortable when tennis elbow is more advanced.
How Is Lateral Epicondylitis Diagnosed?
Dr. Donnelly can often diagnose tennis elbow based on a patient's symptoms, medical history and physical examination.
During the examination, Dr. Donnelly will evaluate the location of the pain and may apply pressure to specific areas around the elbow. He may also ask the patient to move the wrist, fingers or elbow against resistance to determine which movements reproduce the symptoms.
The examination also helps determine whether another elbow, joint or nerve condition could be responsible for the pain.
Imaging is not always necessary to diagnose lateral epicondylitis. However, X-rays, MRI or other diagnostic testing may be recommended when symptoms suggest another condition or additional information is needed.
What Else Can Cause Pain on the Outside of the Elbow?
Pain on the outside of the elbow is not always caused by tennis elbow. Other orthopedic or nerve conditions can sometimes produce similar symptoms.
For example, radial tunnel syndrome can cause pain near the outside of the elbow and upper forearm. Arthritis, injuries involving the elbow joint and other tendon or nerve disorders may also cause symptoms in the same general area.
An accurate diagnosis is important because treatment depends on the underlying cause of the pain.
How Is Tennis Elbow Treated?
Treatment for lateral epicondylitis depends on several factors, including the severity and duration of symptoms, the activities that aggravate the condition and the patient's individual needs.
Most patients are initially treated without surgery.
Non-Surgical Treatment Options for Lateral Epicondylitis
Activity Modification
Reducing or temporarily stopping activities that cause pain can give the injured tendon an opportunity to recover. This does not necessarily mean avoiding all use of the arm. Instead, activities or movements that repeatedly aggravate symptoms may need to be modified while the elbow heals.
Bracing
A brace or forearm strap may help reduce stress on the affected muscles and tendons during certain activities. Dr. Donnelly can determine whether bracing is appropriate based on the patient's symptoms and activities.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Over-the-counter or prescription nonsteroidal anti-inflammatory medications may be recommended to help manage pain and discomfort when medically appropriate.
Physical Therapy and Exercise
Physical therapy can play an important role in treating tennis elbow. A rehabilitation program may include stretching and strengthening exercises designed to improve flexibility, restore strength and gradually increase the tendon and forearm muscles' ability to tolerate activity.
Treatment may also address mechanics or activities that contributed to the problem in an effort to reduce repeated stress on the elbow.
Can thie Condition Heal Without Surgery?
Most cases of tennis elbow can be treated without surgery. Recovery can take time because tendons may heal more slowly than other tissues.
Patients should follow their prescribed treatment and avoid repeatedly returning to painful activities too quickly. As symptoms improve, activities can typically be increased gradually according to Dr. Donnelly's recommendations.
When Is Surgery Considered for Lateral Epicondylitis?
Surgery may be considered when persistent symptoms do not improve after an extended period of appropriate non-surgical treatment.
The decision to consider surgery is individualized. Dr. Donnelly will take into account the severity and duration of symptoms, examination findings, previous treatments, activity level and overall health.
The goal of lateral epicondylitis surgery is generally to address damaged tendon tissue and restore a healthier tendon attachment.
Surgical Treatment Options for Lateral Epicondylitis
Open Surgery
During open tennis elbow surgery, Dr. Donnelly makes an incision near the affected tendon. Damaged tendon tissue can be removed and the tendon repaired as necessary. Depending on the procedure, the tendon may be repaired using sutures or a suture anchor.
Arthroscopic Surgery
Some patients may be candidates for a minimally invasive surgical approach. Dr. Donnelly makes one or two small incisions, he inserts an arthroscope (a thin tube with a tiny camera and light on the end) and watches the monitor attached to the camera. Using the same method as open surgery he will attempt to repair the injured tendon. Some of the benefits of this type of surgery versus open is less postoperative pain, faster healing time, and lower infection rate.
The appropriate surgical technique depends on the patient's condition and individual circumstances.
Recovering From Tennis Elbow
Recovery time varies according to the severity of the condition and the treatment required.
Patients treated without surgery may gradually return to normal activities as pain decreases and strength improves. Returning too quickly to activities involving repetitive gripping, lifting or forceful wrist movements may aggravate symptoms.
Patients who undergo surgery will receive specific postoperative instructions regarding wound care, activity restrictions, rehabilitation and the gradual return to work, recreation or sports.
Following the recommended treatment and rehabilitation plan is important for restoring strength and function and reducing the risk of recurring symptoms.
Lateral Epicondylitis Treatment With Dr. Brandon P. Donnelly
Dr. Brandon P. Donnelly specializes in the diagnosis and treatment of conditions affecting the hand, wrist and elbow. Patients experiencing persistent pain on the outside of the elbow, weakness when gripping or other symptoms associated with lateral epicondylitis can be evaluated to determine the cause of their symptoms and appropriate treatment options.
Treatment is based on the patient's diagnosis, symptoms, activity level and individual needs. When possible, non-surgical treatment is considered before surgery.
Request an Appointment with Dr. Donnelly for evaluation and treatment of tennis elbow and other elbow conditions.
About Brandon P. Donnelly, MD
