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Tennis Elbow

Tennis elbow refers to a sensation of pain in the tendons of the forearm often caused by overuse of the elbow. The pain can occur anywhere from the elbow to the wrist.

The elbow is a hinged joint that is made up of the three bones of the arm: the humerus, the ulna, and the radius. The ends of each of the bones are covered with cartilage, which has a smooth and rubbery consistency that allows the joints to absorb force and shock. Cartilage also allows for the smooth gliding motion of the bones against one another in the elbow joint. These three bones are held together with ligaments that form the joint capsule.  The joint capsule is a sac filled with fluid that lubricates and surrounds the joint, allowing the ends of the bones to slide easily against one another.

The muscles in the forearm cross the elbow and attach to the humerus. Most of the muscles that straighten the fingers and wrist come together and attach to the medial epicondyle which is the bump on the inside of the arm just above the elbow. The outside (lateral) bump just above the elbow is called the lateral epicondyle. This is where pain most commonly occurs regarding Tennis elbow. These tendons (the tricep and bicep tendons) are also both common locations of tendonitis.

Lateral epicondylitis (Tennis elbow) is a painful condition of the forearm that occurs when the tendons that extend from the elbow to the forearm are injured due to overuse and repetitive motions. At its core, Tennis elbow is a muscle strain injury. Repeated contraction of the forearm muscles used in daily or repetitive activities is the main cause of Tennis elbow.

Repeated motions and stress applied to the muscle tissue of the lateral epicondyle results in a series of microscopic tears. These tears populate the lateral epicondyle and increase with overuse and repetitive motions. Those who are most likely to develop Tennis elbow include those whose occupation, activities, or sport requires significant contractions of the muscles in the forearm regularly. Individuals likely to develop Tennis elbow include:

  • Tennis players
  • Baseball players
  • Golfers
  • Carpenters
  • Plumbers
  • Painters
  • Construction workers
  • Those who regularly use a computer mouse
  • Chefs
  • Those between the ages of 30-50

Any pain associated with Tennis elbow will normally radiate from the outside of the elbow or forearm into the wrist. Pain and weakness are the most common symptoms of tennis elbow and occur most when:

  • Shaking hands
  • Gripping an object
  • Opening a door
  • Turning a doorknob
  • Holding a drink

During the physical exam, the physician will apply pressure to the elbow, forearm, and wrist and test them for any tenderness, pain, or inflammation. It is common that a physician asks a patient experiencing symptoms of Tennis elbow to move their arm in various ways. In many cases, a physical exam coupled with previous medical history is enough information to diagnose Tennis elbow. If a physician suspects that another condition is causing symptoms, imaging tests such as XRays, MRIs, or CT (CAT) scans may be ordered.

Tennis elbow and its symptoms often get better with over-the-counter medications and the R.I.C.E. method, which requires rest, icing for 20 minutes every 2 hours, compression of the affected area, and elevation of the arm.

If the injury does not subside, physical therapy is often recommended in order to evaluate the technique of movements in sports or during work. Physical therapists often teach patients exercises in order to gradually stretch and strengthen the muscles and tendons of the elbow and forearm. Eccentric exercises that involve lowering the wrist very slowly after raising it have proven to be very helpful. Forearm straps or braces are also commonly used to reduce stress on the injured muscle tissue.

If these methods do not work, and symptoms persist, procedures including injections, ultrasonic tenotomy, and surgery. Doctors may recommend injecting platelet-rich plasma or botox into the irritated muscle. Ultrasonic tenotomies involve a doctor, under the guidance of ultrasound, inserting a small needle through the skin and into the damaged portion of the tendon. Ultrasonic energy vibrates the needle swiftly so that the damaged muscle tissue is liquified and can be suctioned out of the arm. Surgery to remove damaged tissue is the final option if non-surgical treatment methods prove to be ineffective over the course of a year.

Seeking Treatment

The Center for Orthopaedic Specialists has been providing Ventura County and Los Angeles residents with expert treatment for years. If you are currently experiencing any symptoms of Tennis elbow, or suspect that you have injured your forearm/elbow over time, contact the Center for Orthopaedic Specialists today!

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