What is Tennis Elbow (lateral epicondylitis)

Tennis elbow is inflammation of tendons in your outer forearm, near your elbow. Tendons are tissues that connect muscle to bone. When you have tennis elbow, inflammation affects the tendons that you use to bend your wrist and move your hand up.

Inflammation occurs in the lower part of the upper arm bone (humerus), where the tendons connect to the bone (lateral epicondyle).

Tennis elbow often affects people who play tennis, but anyone may get the condition from repeatedly extending the wrist or turning the forearm.

What are the causes?

This condition is usually caused by repeatedly extending the wrist, turning the forearm, and using the hands. It can result from sports or work that requires repetitive forearm movements. In some cases, it may be caused by a sudden injury.

What increases the risk?

You are more likely to develop tennis elbow if you play tennis or another racket sport. You also have a higher risk if you frequently use your hands for work. Besides people who play tennis, others at greater risk include:

• Musicians.
• Carpenters, painters, and plumbers.
• Cooks.
• Cashiers.
• People who work in factories.
• Construction workers.
• Butchers.
• People who use computers.

What are the signs or symptoms?

Symptoms of this condition include:

• Pain and tenderness in the forearm and the outer part of the elbow. Pain may be felt only when using the arm, or it may be there all the time.
• A burning feeling that starts in the elbow and spreads down the forearm.
• A weak grip in the hand.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history.
• A physical exam.
• X-rays.
• MRI.

How is this treated?

Resting and icing your arm is often the first treatment. Your health care provider may also recommend:

• Medicines to reduce pain and inflammation. These may be in the form of a pill, topical gels, or shots of a steroid medicine (cortisone).
• An elbow strap to reduce stress on the area.
• Physical therapy. This may include massage or exercises.
• An elbow brace to restrict the movements that cause symptoms.

If these treatments do not help relieve your symptoms, your health care provider may recommend surgery to remove damaged muscle and reattach healthy muscle to bone.

Follow these instructions at home:

Activity

• Rest your elbow and wrist and avoid activities that cause symptoms, as told by your health care provider.
• Do physical therapy exercises as instructed.
• If you lift an object, lift it with your palm facing up. This reduces stress on your elbow.

Lifestyle

• If your tennis elbow is caused by sports, check your equipment and make sure that:
  • You are using it correctly.
  • It is the best fit for you.
• If your tennis elbow is caused by work or computer use, take frequent breaks to stretch your arm. Talk with your manager about ways to manage your condition at work.

If you have a brace:

• Wear the brace or strap as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the brace if your fingers tingle, become numb, or turn cold and blue.
• Keep the brace clean.
• If the brace is not waterproof, ask if you may remove it for bathing. If you must keep the brace on while bathing:
  • Do not let it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

General instructions

• If directed, put ice on the painful area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have pain that gets worse or does not get better with treatment.
• You have numbness or weakness in your forearm, hand, or fingers.

Summary

• Tennis elbow (lateral epicondylitis) is inflammation of tendons in your outer forearm, near your elbow.
• Common symptoms include pain and tenderness in your forearm and the outer part of your elbow.
• This condition is usually caused by repeatedly extending your wrist, turning your forearm, and using your hands.
• The first treatment is often resting and icing your arm to relieve symptoms. Further treatment may include taking medicine, getting physical therapy, wearing a brace or strap, or having surgery.

Tennis Elbow Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your elbow. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Wrist extensor stretch

1. Extend your left / right elbow with your fingers pointing down.
2. Gently pull the palm of your left / right hand toward you until you feel a gentle stretch on the top of your forearm.
3. To increase the stretch, push your left / right hand toward the outer edge or pinkie side of your forearm.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

If directed by your health care provider, repeat this stretch except do it with a bent elbow this time.

Exercise B: Wrist flexor stretch

1. Extend your left / right elbow and turn your palm upward.
2. Gently pull your left / right palm and fingertips back so your wrist extends and your fingers point more toward the ground.
3. You should feel a gentle stretch on the inside of your forearm.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

If directed by your health care provider, repeat this stretch except do it with a bent elbow this time.

Strengthening exercises

These exercises build strength and endurance in your elbow. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Wrist extensors

1. Sit with your left / right forearm palm-down and fully supported on a table or countertop. Your elbow should be resting below the height of your shoulder.
2. Let your left / right wrist extend over the edge of the surface.
3. Loosely hold a __________ weight or a piece of rubber exercise band or tubing in your left / right hand. Slowly curl your left / right hand up toward your forearm. If you are using band or tubing, hold the band or tubing in place with your other hand to provide resistance.
4. Hold this position for __________ seconds.
5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Radial deviators

1. Stand with a __________ weight in your left / right hand. Or, sit while holding a rubber exercise band or tubing with your other arm supported on a table or countertop. Position your hand so your thumb is on top.
2. Raise your hand upward in front of you so your thumb travels toward your forearm, or pull up on the rubber tubing.
3. Hold this position for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Eccentric wrist extensors

1. Sit with your left / right forearm palm-down and fully supported on a table or countertop. Your elbow should be resting below the height of your shoulder.
2. If told by your health care provider, hold a __________ weight in your hand.
3. Let your left / right wrist extend over the edge of the surface.
4. Use your other hand to lift up your left / right hand toward your forearm. Keep your forearm on the table.
5. Using only the muscles in your left / right hand, slowly lower your hand back down to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.