What is Tennis elbow (lateral epicondylitis)

Tennis elbow is an overload or overuse condition in which the muscles of the forearm are affected – in particular the muscles that extend the wrist – the ‘backhand’ muscles.

Although the condition is termed ‘tennis elbow’ since it is common in tennis players, only a small proportion of patients actually get the condition from playing tennis.

These muscles attach to the lateral epicondyle of the humerus. Hence the other term for it is lateral epicondylitis – since the ‘common extensor attachment’ is involved due to the repetitive strain.

Statistics on Tennis elbow (lateral epicondylitis)

This is a common condition that typically affects middle aged (40 to 60 years of age) adults. Only 1 in 20 play tennis.

Risk Factors for Tennis elbow (lateral epicondylitis)

This is an overuse disorder with minor trauma, and commonly occurs in people commencing an unaccustomed activity involving the repeated forcible extension of the wrist:

 

  • Playing tennis
  • Using a screwdriver
  • Wringing wet clothes
  • Carrying buckets
  • Picking up bricks
  • Shoveling snow

    Progression of Tennis elbow (lateral epicondylitis)

     

  • The pain may develop gradually or occasionally it may be sudden.
  • At the moment the small tear occurs the patient may feel nothing, though several days later an ache develops.
  • The pain is worse with activities such as turning on taps, turning door handles, shaking hands.
  • The pain often subsides with time if the person abstains from the activity.

    How is Tennis elbow (lateral epicondylitis) Diagnosed?

    No investigations are necessary.

    Prognosis of Tennis elbow (lateral epicondylitis)

    This is not a serious condition, though it can be reasonably disabling in the sense that it limits certain activities, and the person’s work. It usually lasts for months – as long as 24 months, though this depends on treatment and whether the exacerbating activity is stopped.

    How is Tennis elbow (lateral epicondylitis) Treated?

    The mainstay of therapy is:

     

  • Abstaining from exacerbating activities;
  • Gradual stretching and strengthening exercises – such as:
    – wringing exercises – eg rolling up a hand towel, then ‘wringing’ the towel, by first flexing the wrist for 10 seconds, and then extending the wrist for 10 seconds.
    – Weights: sitting with the arms rested, a weight is grasped with the palm facing downwards, and raised by extending and flexing the wrist – gradually increasing the weight.
  • Injection of a corticosteroid and local anesthetic (1ml each) may be tried into the lateral epicondyle – up to 2 injections 2-4 weeks apart may be tried.
  • In severe or difficult to treat cases surgery may be used – which is successful in 70% of cases.
  • After resolution of the condition – the person can gradually return back to the offending activity, though with caution. A non-stretch band or a brace placed 3cm below the elbow may help.

    Tennis elbow (lateral epicondylitis) References

    1. Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002;
    2. Moore, KL, Clinically orientated anatomy 3rd ed; Williams and Wilkins, 1992;
    3. Murtagh, J. General Practice. Second Ed. McGraw-Hill, 1998.