Think You Have Tennis Elbow? Here’s What You Need to Know.
What comes to mind when you hear the words tennis elbow? Some people might picture an avid tennis player with their racquet held high getting ready to pounce. While tennis elbow is prevalent among tennis players, you can develop it even if you don’t know the difference between a breakpoint and backspin.
Tennis elbow occurs for many reasons, most of which are directly related to overuse injuries. So, if you think you have tennis elbow but aren’t positive, you’ve come to the right place.
What is Tennis Elbow?
Tennis elbow, also known as lateral epicondylitis, happens when the tendons that attach your forearm muscles to the outside of your elbow sustain micro tears. Over time, the micro tears can become inflamed, leading to painful symptoms and loss of function. In fact, the pain from tennis elbow can range from mild achiness to debilitating.
But what causes it in the first place? Simply put, overuse is the primary cause of tennis elbow.
Even though the condition is referred to as tennis elbow, this painful condition can happen for a variety of reasons. In addition to sports, tennis elbow can develop due to repetitive work and recreational activities. In fact, you don’t even have to even be an athlete to develop tennis elbow.
Causes of Tennis Elbow
Performing activities that require continued use of the forearm puts you at greatest risk of developing tennis elbow. This includes occupations like painters, carpenters, plumbers, bartenders and line cooks.
Any activity that involves repetitive motion of your wrist such as tennis, painting and even clipping your hedges can cause tennis elbow. It’s estimated that almost 50 percent of all tennis players will develop tennis elbow at one point or another. If you are a tennis player, it’s not uncommon to develop tennis elbow if you do the following:
- Turning or snapping your wrist at full power
- Have a suboptimal form with hypertension of your wrist when performing a one-handed backhand
- Have significant wrist bending with your forehand swing
In addition to tennis, lateral epicondylitis is also seen most frequently in people who play racquetball, lift weights and fence. The continuous gripping motion can strain muscles, which again can lead to tiny tears that cause major pain.
Symptoms
Symptoms of tennis elbow usually come on gradually, so you might not notice them at first. Particularly in cases without injury, it’s easy to write off tenderness to overuse. Usually, the pain is subtle and doesn’t interfere with activities of daily living.
Pain Location
Over time, you may start to experience pain and burning of your outer elbow. You may also have weakened grip strength when shaking hands or and have trouble performing activities that involve the forearm.
If you develop pain, burning at the bony knob of your outer elbow or weakened grip, you could have tennis elbow. Early diagnosis can prevent painful symptoms from getting worse and losing the ability to perform your job or play sports.
Diagnosis
After taking a detailed medical history, your doctor will apply pressure to the area in question. He or she may also ask you to move your arm, elbow, wrist and fingers in various ways to see if this causes pain.
In many cases, your medical history and physical exam are enough to diagnosis tennis elbow. However, if your doctor thinks there may be other possible causes, imaging will be necessary. Radiographic imaging includes x-rays and MRIs.
Treatment Modalities
There are several ways to treat tennis elbow. In many cases, the treatment uses a team approach, which includes your primary doctor or orthopedist, physical therapists and in some cases, an orthopedic surgeon.
Rest
To expedite healing, your doctor may recommend refraining from the activities that caused your initial symptoms.
Medication
In addition to proper rest, your doctor may recommend that you take nonsteroidal anti-inflammatories (NSAIDS). Usually, in the form of aspirin or ibuprofen, both medications work to reduce inflammation.
Steroid Injections
If over-the-counter medication is ineffective, your doctor may also recommend corticosteroid injections for pain relief.
Splints
If you have severe pain, you may benefit from immobilizing your arm in an elbow brace. Oftentimes, immobilization can speed up recovery and help to reduce the pain.
If it’s impossible to avoid using your arm during the day, your doctor might recommend a splint that you can wear at night. Immobilization, even if it’s only at rest, can help speed up the healing process.
Sports Gear
If playing tennis is the cause of your symptoms, you may need to purchase a stiffer racquet with looser strings to use once your doctor clears you for play.
Sports Medicine and Physical Therapy
If you do play tennis, your doctor may ask that you see a sports medicine specialist for an evaluation. He or she will evaluate your tennis technique and make appropriate suggestions. If you’re referred for physical therapy, the therapist will teach you different exercises that not only stretch, but also strengthen your muscles.
Ultrasonic Tenotomy
Under ultrasound guidance, a special needle is inserted through the skin and into the damaged portion of the tendon. Then, using ultrasonic energy to vibrate the needle, damaged tissue is liquified and suctioned out.
Surgical Intervention
Thankfully, even for the most avid of tennis players, only a small percentage will need surgical correction. Most patients consider surgery after failure of conservative treatments and all other possible causes of pain have been ruled out.
Open Surgery
Open surgical correction is still the most common surgical approach for tennis elbow correction. After making an incision over the outer part of your elbow, the surgeon identifies and removes the damaged areas of the tendon.
After the underlying bone is exposed, blood flow is stimulated. Most repairs are completed using suture anchors into the bone. After the incision is closed, your arm is then placed in a splint.
Arthroscopic Surgery
Arthroscopic surgery is another surgical for tennis elbow. Not only is the recovery shorter, but postoperative pain is usually less when compared with open surgery. During arthroscopic surgery, your surgeon makes tiny incisions and inserts portals for both inspection and repair of your elbow.
Through the portals, your surgeon removes damaged tendon without detaching the tendon from the bone. Although still considered a relatively new procedure, the overall success rate of arthroscopic surgery for tennis elbow is high.
Regardless of which surgical procedure is performed, the procedure is usually performed on an outpatient basis. After a period of postoperative monitoring, you are able to go home and follow up with the surgeon as directed.
Risks
As with any type of surgical procedure, there are potential risks. In addition to the possibility of injection, there’s also a risk of injury to nerves and vessels. You may also have permanent loss of flexibility and strength. However, the risks of any these happening are quite low.
Postoperative Care
After surgery, a sterile bandage and a splint are applied. You will have to wear the splint for a week or so until the incisions are healed. Once the sutures are removed, you will then begin gentle range of motion exercises.
Strengthening exercises can be resumed at six weeks after surgery. In the interim, your surgeon will have you perform a series of light exercises to improve flexibility and range of motion of your elbow.
Results
As mentioned above, most patients recover without ever needing surgery. However, if you do find yourself needing surgical repair, note that most people are back to playing tennis or doing what they love the most without residual complaints. For those who continue to have pain, even after surgery, further investigations should be performed to find the cause. Particularly, many athletes suffer from AC joint separation or glenohumeral joint irritation.
Prevention
If you play sports, you can lessen your risk by using the proper technique and by taking the time to stretch before and after play. Lateral epicondylitis, or tennis elbow, mostly affects between the ages of 30 and 50. So, if you fall within the age group, you need to be mindful of possible overuse.
Never Ignore Symptoms
Pain is a signal that your body is trying to tell you something. If you develop pain in your elbow, never ignore painful symptoms. If you do play tennis, you may only have slight irritation or forearm. However, you may have injured the tendon in your elbow as well. Monitor your symptoms and rest your arm for a few days. In many cases, this is all it takes to get you back up to full speed.
However, if you continue to have recurrent pain, reach out to your doctor. Oftentimes, simply resting your arm can help alleviate painful symptoms. However, it’s important to avoid further injury, especially if you do play sports.
Home Treatment
Recovery from tennis elbow will vary. While some people recover in only a few weeks, others may take months before they see an improvement. It all depends on the severity of symptoms, treatment plan and avoidance of causative factors. Severe cases of tennis elbow can take upwards of six to 12 months to heal.
If you want to get back to playing as soon as possible, you may want to take a more proactive approach. Alternate heat and heat for 10 to 15-minute intervals several times throughout the day. Make sure to put a protective layer over the skin to avoid burning or freezing the area. Experiment with both modalities to see what works for you.
Modification of Activities
If your injury is a direct result of playing tennis or another sport, you can always try another sport until you heal. When it comes to work, things are a bit trickier. If possible, ask your employer for modified duties until you are feeling better.
You may need a doctor’s note before your request is approved.
When it comes to lifting, modification is a must. Learn how to use your shoulder and upper arm muscles when lifting things. Try not to bend or straighten your arm all the way out as well. The key is to reduce the impact on your forearm and elbow to promote healing.
Final Thoughts
Even if you don’t play tennis, it is possible to develop tennis elbow. The key to making a quick recovery is knowing what to look for, taking time to rest and also knowing when it’s time for medical intervention. If you do play tennis or another sport that requires repetitive movements, it’s equally important to know when to seek treatment.
Whether you are at risk of getting tennis elbow, or already suffer from it, there are many things you can do to prevent it from reoccurring. While tennis elbow is not an incredibly serious injury, you should take precautions against it.
Untreated, this ailment can lead to riskier and harder to heal trauma. It is recommended that you do everything you can to avoid repetitive motions when possible.
Index
1 https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987
2 https://orthoinfo.aaos.org/en/diseases–conditions/tennis-elbow-lateral-epicondylitis/
3 https://www.webmd.com/pain-management/tennis-elbow#1
4 https://www.webmd.com/fitness-exercise/tennis-elbow-lateral-epicondylitis#1
5 https://www.medicalnewstoday.com/articles/175848.php
6 https://www.emedicinehealth.com/tennis_elbow/article_em.htm