Tennis Elbow: Symptoms, Causes, Diagnosis and Treatment

Tennis elbow is a common cause of elbow pain in adults. It is also known as lateral epicondylitis. It is thought to occur due to degeneration of a muscle called Extensor carpi radialis brevis (extensor of the wrist joint) at its point of origin near the elbow.

The muscle becomes weak because of the degeneration. Now it can not withstand stress applied to it during normal activities. This causes the pain. Pain is intermittent because there are other muscles that perform the same function as Extensor carpi radialis brevis and they compensate for it.

Before reading further please see the Elbow Joint Anatomy to get a better understanding (skip if you have already done so).

Tennis elbow is

equally common in men and women
  • occurs more in the fifth decade (90% of patients) of life
  • Symptoms include

    • pain located on the outer aspect of the elbow
    • pain is increased by activities such as
      1. taking a book from a high shelf
      2. writing on a black board
    • severe and continuous pain along with burning is not present (if you have these symptoms then it is time to reconsider the diagnosis)
    • no swelling is present (if there is swelling then then you have reconsider the diagnosis)

    Diagnosis is established by clinical history and examination. Tenderness is present over the bony prominence on the outer side of the elbow joint.

    Treatment of tennis elbow includes non-surgical and surgical methods.

    The goal of treatment is to replace the degenerated tissue with tough and strong fibrous tissue. This tissue is also less sensitive to pain. This can be done by inducing a inflammatory reaction at the site of degeneration

    Non-surgical methods are

    • restriction of activity that induces the symptoms (may require the use of a splint as it is hard to restrict activities that are a part of your daily routine)
    • use of a brace near the elbow (this slightly loosens the muscle and also serves as a reminder to restrict activity)
    • anti-inflammatory medication
    • exercises to strengthen the musculature
    • steroid injection at the site of tenderness (I have found that a single injection with out the use of local anesthetic agent at the point of maximum tenderness is most effective)
    • manipulation of the wrist (I manipulate the wrist in flexion and pronation with elbow extension 3 days after steroid injection, as by this time the pain of injection has subsided)

    Those patients who fail to response to non-operative treatment are taken for surgery. In surgery the diseased part of the muscle is removed.

    Frequently Asked Questions

    Does alternative medicine have any role in this condition?

    As this condition is not potentially serious so you can try alternative medicine like acupuncture or massage. I have no experience with alternative medicine.

    How many times is steroid injection required?

    Not more than a single injection of steroid is advisable. Too much of steroid can be harmful. When I inject steroid I don't use a local anesthetic agent to numb the area. This increases my accuracy of injection in two ways.

    Firstly, once you inject a local anesthetic agent you produce swelling at the site of the injection. This swelling obscures the bony landmarks and makes pin pointing the site of steroid injection difficult. Secondly, the anesthetic agent numbs the area and now you can not locate the site of injection by eliciting tenderness. Consequently the chances of error increase and it is more likely that the steroid is injected at the wrong site.

    Advocates of injecting local anesthetic agent say that the procedure is now less painful. But I don't agree because injecting the local anesthetic agent it self is painful enough. And that too when you have to inject it twice. First a small dose is injected in the forearm skin for sensitivity (allergic reactions) and second at the site of pain in tennis elbow.

    In this way most of my patients have complete recovery from this condition after steroid injection.

    What are the chances that I may require surgery?

    As more than 90% patients improve by non-operative treatment, chances of you requiring surgery are slim.

    How long does it take to completely recover from surgery?

    Completely recovery takes 2 to 3 months. In some patients it may take about six months.

    Can surgery fail?

    Yes it can. Causes include wrong diagnosis and inadequate release during surgery. Re operation is successful in these cases but before re-operation an MRI of the elbow is a must.

    I hope the information provided was helpful. If you have any query about tennis elbow thenyou can ask me at the contact me page.

    This page was last updated on 11th February 2009.

    Other causes of elbow pain...

    Golfers Elbow

    Radial Head Fracture

    Pulled Elbow

    Olecranon Fracture

    Elbow Dislocation

    Olecranon Bursitis

    Little League Elbow

    Supracondylar Fracture

    Lateral Condyle Fracture

    Elbow Fracture

    Elbow Joint Anatomy

    Go back from Tennis Elbow to Elbow Pain


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