Tennis Elbow
Alternative Names
Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral
Causes, incidence, and risk factors
The part of the muscle that attaches to a bone is called a tendon. Muscles in your forearm attach to the bone on the outside of your elbow.
When you use these muscles over and over again, small tears develop in the tendon. Over time, this leads to irritation and pain where the tendon is attached to the bone.
This injury is common in people who play a lot of tennis or other racquet sports, hence the name "tennis elbow." Backhand is the most common stroke to cause symptoms.
However, any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to this condition. Therefore, painters, plumbers, construction workers, cooks, and butchers are all more likely to develop tennis elbow.
This condition may also be due to constant computer keyboard and mouse use.
References
Regan WD, Grondin PP, Morrey BF. Elbow and forearm. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 19.
Schmidt MJ, Adams SL. Tendinopathy and bursitis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 115.
Review Date: 5/9/2011
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine (8/3/2010).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral
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 based on signs and symptoms, because 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.
X-rays are rarely needed.
References
Regan WD, Grondin PP, Morrey BF. Elbow and forearm. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 19.
Schmidt MJ, Adams SL. Tendinopathy and bursitis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 115.
Review Date: 5/9/2011
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine (8/3/2010).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral
Treatment
The first step is to rest your arm and avoid the activity that causes your symptoms for at least 2 - 3 weeks. You may also want to:
Put ice on the outside of your elbow 2 - 3 times a day.
Take nonsteroidal anti-inflammatory medications (such as ibuprofen, naproxen, or aspirin).
If your tennis elbow is due to sports activity, you may want to:
Ask about any changes you can make in your technique.
Check any sports equipment you're using to see if any changes may help.
Think about how often you have been playing and whether you should cut back.
If your symptoms are related to working on the comptuer, ask your boss about making changes.
An occupational therapist can show you exercises to stretch and strengthen the muscles of your forearm.
You can buy a special brace for tennis elbow at most drug stores. It wraps around the first part of your forearm and takes some of the pressure off the muscles.
Your doctor may also inject cortisone and a numbing medicine around the area where the tendon attaches to the bone. This may help decrease the swelling and pain.
If the pain continues after 6 - 12 months of rest and treatment, surgery may be recommended. Talk with your orthopedic surgeon about the risks, and whether surgery might help.
Expectations (prognosis)
Most people improve with nonsurgical treatment. The majority of those who do have surgery show an improvement in symptoms.
Complications
- Failure to improve with nonsurgical or surgical treatment. This may be due to nerve entrapment in the forearm
- Recurrence of the injury with overuse
- Rupture of the tendon with repeated steroid injections
Calling your health care provider
Apply home treatment (over-the-counter anti-inflammatory medications and keeping the elbow still) if:
Call for an appointment with your health care provider if:
References
Regan WD, Grondin PP, Morrey BF. Elbow and forearm. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 19.
Schmidt MJ, Adams SL. Tendinopathy and bursitis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 115.
Review Date: 5/9/2011
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine (8/3/2010).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral
Prevention
To help prevent tennis elbow:
References
Regan WD, Grondin PP, Morrey BF. Elbow and forearm. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 19.
Schmidt MJ, Adams SL. Tendinopathy and bursitis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 115.
Review Date: 5/9/2011
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine (8/3/2010).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 5/9/2011
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine (8/3/2010).
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.