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Tennis elbow is soreness or
pain on the outer part of the elbow. It happens when you damage the
tendons that connect the muscles of your forearm to
your elbow. The pain may spread down your arm to your wrist. If you don't treat
the injury, it may hurt to do simple things like turn a key or open a
Your doctor may call this condition lateral epicondylitis.
Most of the time tennis
elbow is caused by overuse. You probably got it from doing activities where you
twist your arm over and over. This can stress the tendon, causing tiny tears
that in time lead to pain. A direct blow to the outer elbow can also cause
Tennis elbow is common in tennis players, but most
people get it from other activities that work the same muscles, such as
gardening, painting, or using a screwdriver. It is often the result of using
equipment that is the wrong size or using it the wrong way.
can get tennis elbow, but it usually occurs in people in their 40s.
To diagnose tennis
elbow, a doctor will examine your elbow and ask questions about the elbow
problem, your daily activities, and past injuries. You probably won't need to
X-ray, but you might have one to help rule out other
things that could be causing the pain.
If your symptoms don't get
better with treatment, you might have an imaging test, such as an
MRI. This can tell your doctor whether a bone problem
or tissue damage is causing your symptoms.
You can start treating tennis
elbow at home right away.
After the pain eases, your doctor or
physical therapist can teach you rehabilitation (rehab) exercises to
stretch and strengthen your tendon. Doing these exercises at home can help your
tendon heal and can prevent further injury.
When you feel better,
you can return to your activity, but take it easy for a while. Don't start at
the same level as before your injury. Build back to your previous level slowly,
and stop if it hurts. To avoid damaging your tendon again:
Be patient, and stay with your treatment. You will
probably feel better in a few weeks, but it may take 6 to 12 months for the
tendon to heal. In some cases, the pain lasts for 2 years or longer.
If your symptoms don't improve after 6 to 8 weeks of home treatment, your
doctor may suggest a shot of
corticosteroid. This could give you some short-term
relief so you can start rehab exercises. Surgery is seldom needed for tennis
Learning about tennis elbow:
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Overuse of the forearm muscles
using a repeated twisting motion is the most common cause of
tennis elbow. These movements are common to various
jobs, such as carpentry or plumbing, and to many daily activities, such as yard work
and lifting objects. Racquet sports, swimming, and throwing sports (such as
baseball) can also lead to tennis elbow.
Tennis elbow injuries can result from:
symptoms usually begin gradually. The main symptom is pain, which may begin
with a dull aching or soreness on the outer part of the elbow that goes away
within 24 hours after an activity. As time goes on, it may take longer for the
pain to go away. The condition may further progress to pain with any movement,
even during everyday activities, such as lifting a jug of milk. Pain may spread
to the hand, wrist, other parts of the arm, shoulder, or neck.
Other parts of the arm, shoulder, and neck may also become
sore or painful as the body tries to make up for the loss of elbow movement and
Swelling rarely occurs with tennis elbow. If your elbow
is swollen, you may have another type of condition, such as
Radial tunnel syndrome is an unusual type of nerve entrapment that is sometimes
confused with or can develop at the same time as tennis elbow.
pain is a symptom of tendon injury.
Overuse or stress can cause microtears in the
tendon. This usually occurs because of repetitive motions of the arm or wrist.
The longer you use an injured tendon, the more damaged it becomes.
The most common symptom of tennis elbow is pain on the outside of the
elbow. Given enough rest, the tendon can mend on its own. But if you continue
the activity, the weakened tendon may become more vulnerable to tear or rupture
from a sudden accidental blow, fall, or forceful movement.
early rest and treatment, an injured tendon is likely to heal with minimal scar
tissue and maximum strength. While a recent, mild tendon injury might need a
few weeks of rest to heal, a severely damaged tendon can take months to mend.
Corticosteroid injections may give you short-term pain relief to allow you to
start a rehabilitation (rehab) program. But they may weaken tendon tissue if given
Risk factors for
tennis elbow include:
If you think that your workplace activity is causing elbow
pain or soreness, talk to your human resources department for information on
other ways of doing your job, equipment changes, or other job assignments. For
more information, see the topic
Call your doctor immediately if you had an injury to your elbow and:
Call your doctor if you have:
Watchful waiting is when you and your doctor
watch your symptoms to see if your health improves on its own. If it does, no
treatment is needed. If your symptoms don't get better or they get worse,
then it's time to take the next treatment step.
often helps mild
tennis elbow pain. You may want to try resting the
elbow and applying ice or heat several times a day for 1 to 2 weeks before you call your
For evaluation, diagnosis, or treatment of
tennis elbow, you may see:
You may be referred to a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor can usually determine if
tennis elbow by talking to you about the
history of your symptoms, daily activities, and past
injuries. You'll have a
physical exam too.
X-rays aren't usually needed for diagnosis of tennis
elbow but can sometimes rule out other causes of elbow pain, such as
arthritis, signs of another type of injury, or a
buildup of calcium crystals in a tendon or ligament. X-rays can show unusual
bone structure that might cause soft-tissue damage (such as to tendons or
muscles), but they don't show soft tissues very clearly. If your elbow pain
isn't severe and can't be linked to a specific injury, your doctor may
recommend starting treatment without doing X-rays to see whether the problem
clears up in a few weeks.
If nonsurgical treatment (such as rest,
the use of ice and anti-inflammatory drugs, rehabilitation exercises, and changing or
stopping certain activities) hasn't helped relieve elbow pain, or if the
diagnosis is unclear, other tests may be helpful.
If your doctor thinks you have nerve damage,
electromyogram and nerve conduction tests can check
how well your nerves are working.
Tennis elbow treatment is most often successful. The
most important part of treatment is tendon rest. A long rest from aggravating
activity allows the small tears in the tendon to heal. Depending on how severe
your condition is, you may need to rest your tendon for weeks to months.
Surgery is a last resort if other treatment isn't helpful.
tennis elbow works best when it starts as soon as
symptoms appear. If your condition is just starting, rest may be all you need.
But in most cases, more treatment is needed to protect and heal the
You can treat your tennis elbow
Wrist and elbow splints can be used in the treatment of
tennis elbow. Splints are sometimes helpful for other bone, joint, and tendon
problems. But splints have not been shown to help with pain or recovery for
tennis elbow injuries.
Over the first months of
tennis elbow, continue your initial treatment and
The longer you continue activity that harms the tendon
tennis elbow symptoms begin, the longer rehab will
take. This ongoing activity can cause severe
tendon damage and may someday require surgery. If your
symptoms don't go away, your doctor may suggest:
Your treatment choices will
depend in part on whether elbow pain affects your job or daily life.
It also depends on whether you are willing or able to change habits
or activities that are causing your elbow pain.
treatment is usually started if the injury is:
Most cases of tennis elbow respond to rest, ice, rehab
exercises, pain medicine, and counterforce braces. This injury does take from 6
months to 12 months to heal. Patience helps.
Surgery is considered
as a last resort when all other nonsurgical treatments have failed. You may be
referred for surgery if:
In as many as 9 out of 10 people who have tennis elbow,
symptoms go away and the people can return to their normal activities whether
they have had surgery or not.3
The best way to prevent
tennis elbow is to stretch and strengthen your arm
muscles so that they are flexible and strong enough for your activities.
Other ways to prevent tennis elbow include:
If you feel that certain activities at your job are causing
elbow pain or soreness, talk to your human resources department for information
on other ways of doing your job. They can help with changes to equipment or
other job assignments.
Consider taking lessons to learn the proper
technique for sports, such as tennis and golf, that require grasping and
twisting motions in the arm. Have a sports trainer or a person who is familiar
with sports equipment check yours to make sure it suits your level of ability,
body size, and body strength.
In daily routines or hobbies, look
for activities that use repeated arm movements that strain your fingers, wrist,
or forearm, such as in gardening, cooking, or playing musical instruments.
Train yourself to use techniques that won't stress your elbow. For example,
when you lift objects, lift with the palm of your hand facing upwards.
If you have
tennis elbow, follow these simple steps to reduce pain
tendon healing. A rehab program such as this will
prevent further injury by making your arm muscles stronger.
Along with tendon rest, people often use
medicine to treat
tennis elbow. Medicine can help with pain and relieve
or reduce swelling.
Nonsteroidal anti-inflammatory drugs (NSAIDs), including
aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen (such as
Aleve), are the
most commonly used medicines for treating tennis elbow. NSAIDs are available
with or without a prescription. NSAIDs come in pills and in a cream that you rub over the sore area. Acetaminophen (such
as Tylenol) can also help with pain. Be safe with medicines. Read and follow all instructions on the label.
Your doctor may suggest
corticosteroid injections (shots) if you are still in
pain after at least 6 to 8 weeks of tendon rest and rehab. Corticosteroids are
a class of powerful anti-inflammatory medicine. Even though inflammation isn't
usually present in long-term (chronic) tennis elbow, corticosteroid shots may
ease elbow pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid shots
don't cure tennis elbow. But they can reduce pain and give you enough relief to
Avoid taking NSAIDs or other pain relief medicine to
control pain if you are continuing activities that can further damage your
tendon. If you don't feel the pain, you won't know that your elbow is getting
Most cases of
tennis elbow are treated without surgery. Less than 5 out of 100 cases
require surgery.2 You and your doctor might consider
surgery if several months of
tendon rest and rehabilitation (rehab) haven't stopped the pain or returned
the flexibility and strength to your forearm.
During surgery, a doctor will most likely cut (release) the
tendon, remove damaged tissue from the tendon, or both. In some cases, tendon
tears can be repaired.
After surgery, rehab is needed to restore
flexibility and strength in the forearm.
Surgery for tennis elbow involves
cutting (releasing) the tendon and removing damaged tissue from the tendon. In
some cases, tendon tears are repairable (reattached) if the repair can be done
without overtightening the tendon. These procedures can be done both
arthroscopically and through a larger incision (open
surgery) or with a combination of the two techniques.
There are different approaches
to surgery for tennis elbow, such as where to enter the elbow and what type of
reconstruction or repair on the tendon is done. Surgical technique is
determined by the type, location, and severity of the injury and by the
doctor's preference and experience.
There is no strong medical
research that shows that one type of surgery is better than another or that
surgery is better than other treatment.4
The success of surgery depends in large part on the amount of time and
effort you put into a rehab program.
Other treatment for
tennis elbow pain includes physical rehabilitation (rehab),
acupuncture, topical nitric oxide, shock wave therapy, and
transcutaneous electrical nerve stimulation
Physical rehab is combined with
tendon rest to restore flexibility and build muscle
strength. Rehab is needed after surgery too.
A physical rehab program includes:
Complementary or alternative treatments are
sometimes used along with traditional therapy to treat tennis elbow. Although
there is no solid scientific evidence that these therapies relieve pain and
restore elbow flexibility and strength, some people report them as helpful.
Complementary or alternative treatments may include:
A physical rehab program not
only helps heal injured tendons and muscles but also helps prevent further
Physical rehab combined with tendon rest is the main
tennis elbow treatment. Corticosteroid shots are only considered if several
weeks of rest and rehab have not reduced symptoms. Surgery may be considered
after 6 to 12 months of nonsurgical treatment.
If the type of work
you do is causing your injury,
an occupational therapist may help you change how you
are working or the kind of work that you do.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The American College of Sports Medicine (ACSM) provides general
information and publications about exercise and sports medicine.
ASSH is a professional organization of hand surgeons
that provides education to the public about hand problems, such as Dupuytren's
disease, carpal tunnel syndrome, and tennis elbow. ASSH also provides education
about surgery, preventive tips to keep your hands safe, and an online tool to
find a hand surgeon.
Coombes BK, et al. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: A systematic review of randomised controlled trials. Lancet, 376(9754): 1751–1767.
American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Medial and lateral epicondylitis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 370–374. Rosemont, IL: American Academy of Orthopaedic Surgeons.
Rasouli A, Gupta R (2007). Elbow, wrist, and hand injuries. In PJ McMahon, ed., Current Diagnosis and Treatment in Sports Medicine, pp. 146–159. New York: McGraw-Hill.
Buchbinder R, et al. (2011). Surgery for lateral elbow pain. Cochrane Database of Systematic Reviews (3).
Bissett L, et al. (2011). Tennis elbow, search date June 2009. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Paoloni J, et al. (2003). Topical nitric oxide
application in the treatment of chronic extensor tendinosis at the elbow.
American Journal of Sports Medicine, 31(6): 915–920.
Buchbinder R, et al. (2005). Shock wave therapy for
lateral elbow pain. Cochrane Database of Systematic Reviews (4). Oxford: Update Software.
Other Works Consulted
Regan WD, et al. (2010). Tendinopathies around the elbow. In JC DeLee et al., eds., DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice, 3rd ed., pp. 1197–1213. Philadelphia: Saunders Elsevier.
Chiou P, Borg-Stein J (2010). Cumulative trauma disorders. In WR Frontera, ed., DeLisa's Physical Medicine and Rehabilitation, 5th ed., vol. 1, pp. 923–936. Philadelphia: Lippincott Williams and Wilkins.
Hertling D, Kessler RM (2006). Elbow and forearm. In D Hertling, RM Kessler, eds., Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, 4th ed., pp. 357–390. Philadelphia: Lippincott Williams and Wilkins.
Wise C (2011). Back pain and common musculoskeletal problems. In EG Nabel, ed., ACP Medicine, section 17, chap. 10. Hamilton, ON: BC Decker.
January 10, 2013
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine
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