'Tennis Elbow': Villain Is Overuse, So Give It A Rest

Ask The Expert

Dr. Christina Marie Morganti, Anne Arundel Medical Center

August 03, 2009

Christina Marie Morganti, an orthopedic surgeon specializing in sports medicine with the Orthopaedic & Sports Medicine Center, explains "tennis elbow" - also known as lateral epicondylitis - and how to take care of it.

* "Tennis elbow" is a tendinosis of the wrist and finger extensor muscles that occurs where they originate on the outside of the elbow. This area is where the tendons of the four to five muscles on the back of the forearm coalesce into one "common extensor tendon." Similar to this is "golfer's elbow," or medial epicondylitis, which refers to tendinosis of the wrist and finger flexor muscles on the inside (medial side) of the elbow.

This is called tendinosis instead of tendinitis because it has more of a degenerative characteristic than an inflammatory one. It is thought to be a process related to overuse of the muscle group involved; in the case of tennis elbow, that means overuse of the wrist extensors, especially the main muscle that stabilizes the wrist for grip strength.

* Tennis players are prone to this, but not exclusively. It is seen frequently in other athletes such as fencers and throwers, as well as many people who do repetitive work such as carpentry or computer mouse work. Tennis elbow may be, to a certain extent, hereditary; some people are inherently more prone to tendinosis in general.

* In tennis elbow, the outside (lateral side) of the elbow becomes painful to the touch. This can progress to pain even with simple activities that require grip strength, such as hand-shaking, turning doorknobs or keys, or lifting a carton of milk. There is usually no sort of deformity, but occasionally some swelling can be seen. Many people feel a sense of weaker grip strength related to the pain. This can be an annoying, frustrating problem because the symptoms tend to linger over a long period of time.

* Treatment involves the usual treatment for any overuse malady: rest. Yet this can be difficult, because this muscle group is used with many activities of daily living. To combat this, a tennis elbow strap (also called a counterforce brace) can be worn when doing activities. It is worn just below the common tendon, theoretically making the wrist extensors muscles more efficient and giving a relative rest during activity. Checking equipment and technique for modifiable factors can also help - for example, adjusting a racket grip or shortening workouts. Ice also sometimes helps with the discomfort.

* What really "cures" the problem is strengthening the muscle-tendon unit, so that the offending activity isn't too stressful for it. This can be accomplished with a series of exercises, which must be done consistently. Cortisone shots are another option.

Surgery is usually only considered if symptoms persist six months or more despite best efforts with nonsurgical options. Activity is usually restricted for about six weeks after surgery, then gradually increased with the tennis elbow brace on over the next several months.

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