Tennis elbow

Alternative names
Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral

Definition
Tennis elbow is an inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow. There may be a partial tear of the tendon fibers, which connect muscle to bone, at or near their point of origin on the outside of the elbow.

Causes, incidence, and risk factors

This injury is caused by repetitively twisting the wrist or forearm. The injury is classically associated with tennis playing, hence the name “tennis elbow,” but any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to lateral epicondylitis.

Symptoms

     
  • Elbow pain that gradually worsens  
  • Pain radiating from the outside of the elbow to the forearm and back of the hand when grasping or twisting  
  • Weak grasp

Signs and tests

The diagnosis is made by clinical signs and symptoms, since X-rays are usually normal. Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow

There is also pain near the elbow when the wrist is extended (bent backwards, like revving a motorcycle engine) against resistance.

Treatment

Treatment is aimed at pain relief and reducing inflammation. Treatment methods include:

     
  • Nonsteroidal anti-inflammatory medications (such as ibuprofen, naproxen or aspirin)  
  • Local injection of cortisone and a local anesthetic into the affected area  
  • Immobilization of the forearm and elbow with a splint for 2 to 3 weeks  
  • Heat therapy  
  • Physical therapy

To prevent the recurrence of the injury, a splint may be worn during aggravating activities, or the activities may need to be modified. If the pain persists despite these nonoperative treatments, surgery may be necessary.

Expectations (prognosis)
Over 90% of people improve with non-surgical treatment. Of the 10% that need surgery, 90% of these experience subsequent relief.

Complications

     
  • Recurrence of the injury with overuse  
  • Rupture of the tendon with repeated steroid injections  
  • Failure to improve with nonoperative or operative treatment; these may be due to nerve entrapment in the forearm

Calling your health care provider

Apply home treatment (over-the-counter anti-inflammatory analgesics and immobilization) if symptoms are mild or if you have had this disorder before and you know this is what you have.

Call for an appointment with your health care provider if this is the first time you have had these symptoms, or if home treatment does not relieve the symptoms.

Prevention

Maintain good strength and flexibility in the arm muscles or avoid repetitive motions. Rest the elbow when flexion and extension is painful. An ice pack applied to the outside of the elbow after repetitive motion may help alleviate symptoms.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.