Tennis elbow (aka lateral epicondylitis) is a degenerative condition of the tendon that attaches to the bony part of the elbow from chronic overuse and abuse. The tendons involved are those that anchor the muscles of the wrist and hand to lift and raise the wrist. Ask anyone who has suffered from the symptoms of tennis elbow pain and they’ll confirm that this condition is painful. Tennis elbow pain is generally experienced by people between 30 and 50 and can affect half of all athletes who play racket sports. The specific action that causes injury and inflammation is generally the use of the backhand stroke with a poor technique.
But not all people who are affected are athletes. The factor that most affects the development of the condition is the repetitive and vigorous use of the forearm, such as in racket sports, meat cutting, fencing, plumbing, painting, raking and weaving. The burning pain of tennis elbow on the outside of the arm often starts slow and worsens over weeks and months. The pain is felt with pressure over the outside of the elbow or by using the forearm by gripping or lifting objects. The pain is similar to golfers elbow except that the golf elbow pain is on the inside of the elbow where this is on the outside of the elbow.
Diagnosing Tennis Elbow Pain
People who experience tennis elbow will complain that they aren’t able to grip objects well, turn door knobs, and may even feel pain at rest. If the injury appears minor you may think about treatment at home but if you don’t strengthen the joint appropriately, then going back to the activities you weren’t doing properly before will just result in the same (or even worse) condition. If the elbow can’t be bent, is swollen, hot, inflamed, you have a fever or the elbow appears deformed you should see the doctor immediately. Complications from a severe tennis elbow or a condition that may at first appear as a tennis elbow injury can have devastating long term affects.
To diagnose the problem your doctor will first take a complete medical history looking for causative actions that may have contributed to the development of the condition. They will ask about activities, when you may have first noticed the condition, what you do each day and how this has been impacting your day. Moving on, they will then perform a physical examination comparing the injured elbow and arm against the other side. They’ll apply pressure on the elbow to see if it elicits pain or moves the fingers and wrist.
X-rays to diagnose tennis elbow aren’t necessary and don’t show anything on the image with regards to the tendon, but they may reveal other problems that appear as tennis elbow for which the treatment will be different. In some cases, although rare, the doctor may ask for an MRI to get an image of the tendon if they feel there is significant damage.
Treatment For Tennis Elbow Pain
Initial treatment of tennis elbow involves several common sense self-care steps such as applying ice (or cold therapy wraps designed for the elbow) to the joint, such as:
Your doctor may also suggest anti-inflammatory medications, such as ibuprofen, to decrease the inflammation in the joint and help it to heal faster. Lastly, they will most likely recommend that you stop the activities that you know have caused the condition in the first place. Continuing your activities through the pain will cause greater damage to the tendon that may require surgery to repair.
Once you have the pain under control you will want to evaluate how you use your arm with the assistance of a physical therapist. If you are using your arm inappropriately during a sporting activity and can change the motion or find alternative mechanisms to help, you’ll reduce your risk of having this happen again. If the pain doesn’t go away in a reasonable amount of time your doctor may suggest that you consider steroid injections directly into the joint to help decrease the inflammation and pain in joint. However, there is no clear long-term benefit to injection over physical therapy. This means that physical therapy provides the same benefits short term and will give more long term pain relief than a shot of steroid.
For more serious conditions, your doctor may ask you to consider surgery to repair the joint. Before considering this option you should have been consistent with physical therapy for at least 1 year, have limited motion in the elbow and are still experiencing significant pain.
Surgery for Tennis Elbow
In most cases, surgery is a treatment of last resort after every other non-invasive treatment methods have been exhausted, without the desired results. If you still feel pain after 6 to 12 months of treatment, surgery might be the only solution for your tennis elbow problem. Surgery for tennis elbow is a minor surgery and most of the time, its an outpatient surgery which takes a little amount of time and anesthetization. It is usually performed by orthopedic surgeons who are trained in sports medicine.
In tennis elbow surgery, damaged muscle and tendon tissue are removed from the lateral epicondyle bone (see above) and then reattached to surrounding tissues that are still healthy. A success rate of 80 to 90 percent for full recovery from symptoms is common with tennis elbow surgery. Before the surgery, you will be given an anesthetic to numb the affected area so that you don’t feel any pain during the surgery. The two surgical treatment options available for tennis elbow include:
- Open surgery of the elbow: The surgeon makes an incision of about 3-4 centimeters long over the injured tendon and the damaged part is scraped off. The surgeon may stitch back the tendon to surrounding healthy tendons. The surgeon may also use a suture anchor to repair the tendon. When the surgery is over, stitches are used to close up the cut.
- Arthroscopic surgery of the elbow: In this surgery, a device known as an arthroscope is inserted into the elbow. The device is a thin tube a with small camera and light at the end. After anesthetizing you, the surgeon makes one or two small cuts on your elbow and inserts the scope. The scope shows the interior of your elbow on a monitor and the surgeon uses the video to guide small surgical tools which are used to scrape off the unhealthy parts of your tendon. After the procedure, the incision is stitched back up.
Getting Ready For Elbow Surgery
These tips may help you get ready in the event that you have upcoming elbow surgery:
- You must tell the surgeon about any medicine you are using including prescriptions and over the counter drugs such as supplements, vitamins, and herbs.
- Some drugs make blood clotting difficult. You will be advised to stop drugs such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), and aspirin. Follow this instruction as your surgery involves some amount of bleeding.
- Smoking slows down the healing process. Try to stop smoking before performing the surgery.
- Ask your health care provider about medicines that you can continue to take until the day of your surgery.
- If you have a sickness such as a fever, flu, or cold, make sure you tell the surgeon before your surgery.
- You will be told not to eat or drink anything before the surgery, adhere to this instruction.
- Don’t be late for your surgery. Arrive at the time the surgeon gave you.
Keep in mind that these are just general guidelines. You should be given a list before the surgery with the exact steps you need to take in order to get ready. If not, ask for one. After the surgery, expect to have your elbow and arm wrapped in a thick bandage or splint. You can return home after the anesthetic wears off. You will be given medicines and instructions on how to care for your elbow. Make sure you follow the instructions for quick recovery. One more thing, consider purchasing a cold therapy wrap to get rid of some of the swelling and to speed up the recovery process. For example, the SimplyJnJ Cold Therapy Elbow Wrap (seen above).
Although tennis elbow pain is common among those who consistently use their forearms, there are only 10% of those who experience the symptoms who may need surgery to repair the tendon. With a strong rehabilitation program, consistent therapy, and re-evaluation of how you use your arm, re-occurrence of the condition is highly unlikely. In the meantime, have a look at our Elbow Pain Treatment section of our Shop for some ideas on how to get relief today.
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MedlinePlus: Tennis Elbow
SportsInjuryClinic: Tennis Elbow/Lateral Epicondylitis