Tennis elbow


By Joseph M. Harris, PT, ATC, CEAS - President/Clinical Director - Physical Therapy Solutions, PSC



Tennis elbow is also called lateral epicondylitis. It is a painful condition occurring in the elbow. It is inflammation of the tendons of the forearm at their attachment to the outside of the elbow. The muscles that are responsible for lifting the hand and extending the wrist have their attachment on the bony bump on the outside of the elbow. The condition occurs as a result of microscopic tears due to overuse or increased stress to the wrist extensor muscles.

While lateral epicondylits is common occurrence related to the groundstroke and backhand in tennis, athletes are not the only ones at risk for this condition. This is a very a common injury that occurs as a result of work or recreational activities that require vigorous or repetitive use of the forearm. The condition commonly occurs in factory workers, cooks, butchers, painters, carpenters, and plumbers. Any occupation requiring repetitive gripping activities, especially with the palm down, may make a person more prone the this injury. It is also common in athletes who use improper technique or inadequate equipment for their sports. It most commonly occurs in individuals between the ages of 30 and 50 but can and does occur in persons of any age. Sometimes a cause cannot be specifically identified.

The condition typically begins with mild pain on the outside of the elbow. The pain typically gradually and slowly increases over the course of a few weeks to a few months. The dominant arm is most often affected. Symptoms are typically pain and aching over the outside of the elbow and a weak and painful grip. The pain is typically worse when a tool is used in the hand or when the hand is used with the palm down.

Treatment typically includes rest from the causative activity. Rest includes decreased time involved in the activity and varies from total rest to reduction in time exposed to the causative activity. A brace will also allow decreased stress to the specific area of inflammation. Equipment and tools can be modified to reduce the stress to the elbow. Larger grip handles that provide a better gripping surface will require the person to reduce the force of the grip required to perform the work. Also, be sure the tool is shaped properly for the task at hand and that good ergonomics are used. Stiffer racquets that are loosely strung can reduce the amount of stress on the elbow and the forearm muscles.

Physical therapy is effective in reducing the inflammation and improving healing of the involved muscles. The physical therapist will also provide specific exercises to improve strength and flexibility of the forearm muscles. Steroid injections help to reduce inflammation and promote healing. Surgical treatment may be considered if the condition does not respond to conservative treatment. Typically surgery is only considered when symptoms are not alleviated after six to 12 months of conservative treatment.

If you are having pain on the outside of your elbow or forearm, consult your physical therapist or other health care provider so that proper treatment can be administered before the injury progresses to the later stages.

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By Joseph M. Harris, PT, ATC, CEAS

President/Clinical Director

Physical Therapy Solutions, PSC

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