Tennis Elbow Basics

Tennis elbow, or lateral epicondylitis, is the most common injury in patients seeking medical attention for elbow pain. Exactly what causes tennis elbow is unknown, but it is thought to be due to small tears of the tendons that attach forearm muscles to the arm bone at the elbow joint.

The muscle group involved, the wrist extensors, function to cock the wrist back. Specifically, the extensor carpi radialis brevis has been implicated in causing the symptoms of tennis elbow.

WHAT ARE THE SYMPTOMS OF TENNIS ELBOW?

Patients with tennis elbow syndrome experience pain on the outside of the elbow that is worsened by grasping objects and cocking back the wrist. The most common symptoms of tennis elbow are:

• Pain over the outside of the elbow
• Pain when lifting objects
• Pain radiating down the forearm

The pain associated with tennis elbow usually has a gradual onset, but it may also come on suddenly. Most patients with tennis elbow are between the ages of 35 and 65 years old, and it affects about an equal number of men and women. Tennis elbow occurs in the dominant arm in about 75 percent of patients. Anyone can be affected, but tennis elbow is most commonly seen in two groups of people:

• Manual Laborers
  People who work with their hands are at greater risk of developing tennis elbow. Jobs that may lead to tennis elbow include plumbers, painters, gardeners, and carpenters.
• Sports Participants
  Sports participants, especially racquet sport players, are prone to developing tennis elbow. About a third of regular tennis players experience tennis elbow at some point in their careers. In addition to racquet sports, tennis elbow is seen in golfers, fencers, and other sports participants.

ARE SPECIAL TESTS NEEDED TO DIAGNOSE TENNIS ELBOW?

X-rays of patients who have the diagnosis of tennis elbow are almost always normal. Other tests, such as an EMG, are sometimes conducted if there is confusion about the diagnosis.

Other causes of pain over the outside of the elbow include instability of the joint, elbow arthritis, and radial tunnel syndrome. The symptoms of these conditions are usually distinct, but in some cases they can be confusing.

WHAT IS THE PROBLEM OCCURRING IN TENNIS ELBOW?

No one knows for certain, but there are several ideas. It is known that tennis elbow is not simply an “inflammation” of the tendons around the joint. The problem is thought to be more of a degenerative process as a result of aging or repetitive use. The symptoms may be the result of an incomplete healing response in an area that does not have good blood flow and therefore has difficulty accessing nutrition and oxygen necessary for healing. This leads to degeneration of the tendon causing small tears.

WHEN DO I NEED TO SEE THE DOCTOR FOR TENNIS ELBOW?

Bring the following symptoms to your doctor’s attention:

• Inability to carry objects or use your arm
• Elbow pain that occurs at night or while resting
• Elbow pain that persists beyond a few days
• Inability to straighten or flex your arm
• Swelling or significant bruising around the joint or arm
• Any other unusual symptoms

WHAT SHOULD I DO ABOUT IT?

• Rest your arm (take a break for a bit!)
  
• Have your racquet strings and grip size checked by a Professional Racquet Technician
  If you have pain while playing or after playing, you may be able to relieve it by using a specialized “tennis elbow” string in your racquet or just a softer (multi-filament) string that will absorb more shock than many basic, firmer strings.  String Tension should be lower for those suffering elbow pain, again to minimize shock to the arm.  Grip Size should be professionally measured.  If you are using a grip that is either to large or too small for your hand it can be a trigger for elbow problems. If you are in the market for a new racquet, make sure to consider many of the new racquet technologies offering added shock absorption to the frame and remember, heavier is better as far as racquet weight and frame flexibility for shock absorption.*

  *there is a point where too heavy a racquet results in the Player working harder to swing it than they should at which point the added weight becomes a hindrance, not a help in the arena of tennis elbow concerns. This point is specific to each Player depending on physique and technique.

• Improve your stroke mechanics & racquet preparation
  Stroke mechanics should be evaluated to ensure patients are hitting the ball in the center of the racquet; players should not lead the racquet with a flexed elbow. See a tennis pro/instructor for a swing and racquet evaluation.
• Wear a Tennis Elbow Band
  There are several styles of Tennis Elbow Braces that work alleviate the pain. Most can be worn during play as well as throughout daily routines as needed for pain control. They utilize varying technologies to apply pressure to the extensor muscle in the forearm as well as to keep the area warm.
• Stretch / Exercise the muscles from the wrist to the elbow
  There are several basic stretches that can be performed throughout the day to improve flexibility and possibly relieve some of the pain.  Stretching before and following play can also help alleviate some of the pain.

Word of Caution…for persistent pain or any uncertainty about your condition immediately contact your health care professional.