Steve K. Lee, MD
Steve K. Lee, MD, Chief of the Hand and Upper Extremity Service at Hospital for Special Surgery in New York City.
You don’t have to play tennis to get tennis elbow. In fact, most people who develop this painful condition are not racket-sports enthusiasts.
Instead, they are hairdressers, gardeners, knitters, or anyone who puts repetitive strain on the muscles and tendons of the forearms. Some people develop tennis elbow after an injury. Others develop it without any apparent cause.
The condition, formally known as lateral epicondylitis, can be so painful that people abandon favorite sports or hobbies or can no longer do their jobs. The good news: It’s treatable, usually without surgery.
To understand what causes the pain in the first place, it helps to know a little anatomy. The muscles in your forearm are responsible for the extension of your wrists and fingers. Your forearm tendons, or extensors, attach these muscles to your upper arm bone at a bony point in your elbow called the lateral epicondyle. Over time, heavy use of your wrists and forearms can cause the tendon to pull away from the bone and develop small tears.
The main symptom of tennis elbow is a distinctly painful spot on the outer elbow. The pain usually starts gradually and gets worse over time. It tends to be most noticeable when you use your wrists and forearms, especially with twisting motions. For some people, even shaking hands is painful.
If you go to your doctor with elbow pain in the spot typically associated with tennis elbow, he or she likely will press on the spot to confirm the location of the discomfort, and ask how long you have had the pain and when you tend to notice it most. In many cases, you also will get an MRI scan to confirm the diagnosis.
If you have a clear-cut case of tennis elbow, you might not need any other tests. But if the diagnosis is not clear, you might get a more extensive workup. For example, you might get an X-ray to rule out arthritis in your elbow.
Once you know you have tennis elbow, the first thing to try is resting the affected arm for about a month. Stop or cut back on activities that aggravate your condition. That’s not too hard if your pain is caused by recreational tennis or backyard gardening, but if the aggravating activities are part of your job, taking a break can be tougher. If needed, a doctor may write to your employer saying that you temporarily need different duties or a few weeks off.
During this time, try wearing a brace on your wrist. While wearing a wrist brace when your elbow hurts might seem counterintuitive, the idea is to support and rest the affected tendon at the point where it originates. Look for a brace that gently holds the wrist in a “cocked up” position. These are widely sold in drug stores and online.
You can take ibuprofen, naproxen, or other other-the-counter analgesics to control pain for a few days. But, because taking those medications for a long time can have side effects, such as ulcers and stomach bleeding, you might want to try an anti-inflammatory gel that you can apply directly to the painful area. Effective products containing the active ingredient diclofenac are available over the counter. Studies suggest they produce fewer side effects than pills do.
Some doctors also advise applying ice when your elbows hurt, especially when you first notice the pain. Apply ice or cold packs for 10 to 15 minutes several times a day. Put a cloth under the ice to protect your skin.
If you still have symptoms after a month of rest, bracing, and pain management, your next stop should be a physical therapy clinic. A therapist can work with you on gentle exercises to stretch and strengthen the muscles in your forearm.
If your pain persists, you may want to try a shot of cortisone, a potent anti-inflammatory agent that is injected directly into the painful area. Tennis elbow is not caused by inflammation, but the shots seem to help some people. If one shot does not provide adequate relief, your doctor may recommend a second shot after six to eight weeks.
Some doctors offer an additional therapy known as platelet-rich plasma (PRP). Platelets, which are blood cells that aid clotting and contain substances that might aid healing, are obtained from your own blood and injected into the affected area. Studies of the therapy have produced mixed results. Another experimental approach is using ultrasound or shock waves to promote healing.
Whatever approach you take, you should know that most patients get better within several months.
If you don’t get better after six to nine months, you may be among the 10 to 20 percent of patients who are candidates for surgery. In the most common procedure, your surgeon will make one cut over your injured tendon and remove the damaged tissue. The tendon is then repaired. Less commonly, surgery is done with an arthroscope, a thin tube with a tiny camera and light that is inserted through a few small cuts. The surgeon uses a video monitor to see and remove the unhealthy part of the tendon. Neither kind of surgery requires an overnight hospital stay.
After surgery, you may need to wear a splint on your arm for a couple of weeks and then a wrist brace for a couple more. After that healing period, you will start gentle exercises to restore motion, followed by several weeks of strengthening exercises.
About 80 percent of people who have tennis elbow surgery get relief from their pain and can return to their usual activities as long as they take care to prevent new damage by using proper form during sports and hobbies and avoiding overdoing it at work, for instance.
Others may have to make bigger lifestyle changes or try repeated treatments to keep their elbows in good working form.
