Tennis Elbow

Overview

Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.

Despite its name, athletes aren't the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters and butchers.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to a bony bump on the outside of your elbow. Pain can also spread into your forearm and wrist.

Rest and over-the-counter pain relievers often help relieve tennis elbow. If conservative treatments don't help or if symptoms are disabling, your doctor might suggest surgery.

Tennis elbow care at Mayo Clinic

Symptoms

The pain associated with tennis elbow may radiate from the outside of your elbow into your forearm and wrist. Pain and weakness may make it difficult to:

• Shake hands or grip an object
• Turn a doorknob
• Hold a coffee cup

When to see a doctor

Talk to your doctor if self-care steps such as rest, ice and use of over-the-counter pain relievers don't ease your elbow pain and tenderness.

Causes

Tennis elbow is an overuse and muscle strain injury. The cause is repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in a series of tiny tears in the tendons that attach the forearm muscles to the bony prominence at the outside of your elbow.

As the name suggests, playing tennis — especially repeated use of the backhand stroke with poor technique — is one possible cause of tennis elbow. However, many other common arm motions can cause tennis elbow, including:

• Using plumbing tools
• Painting
• Driving screws
• Cutting up cooking ingredients, particularly meat
• Repetitive computer mouse use

Risk factors

Factors that may increase your risk of tennis elbow include:

• Age. While tennis elbow affects people of all ages, it's most common in adults between the ages of 30 and 50.
• Occupation. People who have jobs that involve repetitive motions of the wrist and arm are more likely to develop tennis elbow. Examples include plumbers, painters, carpenters, butchers and cooks.
• Certain sports. Participating in racket sports increases your risk of tennis elbow, especially if you employ poor stroke technique.

Diagnosis

During the physical exam, your doctor may apply pressure to the affected area or ask you to move your elbow, wrist and fingers in various ways.

In many cases, your medical history and the physical exam provide enough information for your doctor to make a diagnosis of tennis elbow. But if your doctor suspects that something else may be causing your symptoms, he or she may suggest X-rays or other types of imaging tests.

Treatment

Tennis elbow often gets better on its own. But if over-the-counter pain medications and other self-care measures aren't helping, your doctor may suggest physical therapy. Severe cases of tennis elbow may require surgery.

Therapy

If your symptoms are related to tennis, your doctor may suggest that experts evaluate your tennis technique or the movements involved with your job tasks to determine the best steps to reduce stress on your injured tissue.

A physical therapist can teach you exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm. Eccentric exercises, which involve lowering your wrist very slowly after raising it, are particularly helpful. A forearm strap or brace may reduce stress on the injured tissue.

Surgical or other procedures

• Injections. Your doctor might suggest injecting platelet-rich plasma, Botox or some form of irritant (prolotherapy) into the painful tendon. Dry needling — in which a needle pierces the damaged tendon in many places — can also be helpful.
• Ultrasonic tenotomy (TENEX procedure). In this procedure, under ultrasound guidance, a doctor inserts a special needle through your skin and into the damaged portion of the tendon. Ultrasonic energy vibrates the needle so swiftly that the damaged tissue liquefies and can be suctioned out.
• Surgery. If your symptoms haven't improved after six to 12 months of extensive non-operative treatment, you may be a candidate for surgery to remove damaged tissue. These types of procedures can be performed through a large incision or through several small incisions. Rehabilitation exercises are crucial to recovery.

Lifestyle and home remedies

Your doctor may recommend the following self-care measures:

• Rest. Avoid activities that aggravate your elbow pain.
• Pain relievers. Try over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve).
• Ice. Apply ice or a cold pack for 15 minutes three to four times a day.
• Technique. Make sure that you are using proper technique for your activities and avoiding repetitive wrist motions.

Preparing for your appointment

You're likely to first bring your problem to the attention of your family doctor. He or she may refer you to a sports medicine specialist or an orthopedic surgeon.

What you can do

Before your appointment, you may want to write a list that answers the following questions:

• When did your symptoms begin?
• Does any motion or activity make the pain better or worse?
• Have you recently injured your elbow?
• What medications or supplements do you take?

What to expect from your doctor

Your doctor may ask some of the following questions:

• Do you have rheumatoid arthritis or a nerve disease?
• Does your job involve repetitive motions of your wrist or arm?
• Do you play sports? If so, what types of sports do you play and has your technique ever been evaluated?