Lateral Epicondylitis (Tennis Elbow)

What is it?

Lateral epicondylitis occurs with pain and inflammation on the outer side of the elbow where the muscles that extend the wrist attach to the bone. This can occur not only in tennis players but in anyone who performs repeated motions of the wrist. (See Figure 1)

What are the symptoms?

Commonly this occurs with pain and tenderness on the outside or lateral side of the elbow, pain or weakness with gripping or twisting of the wrist, and pain with lifting objects.

What are the causes?

Epicondylitis is caused by repetitive stress and strain to the muscles and tendons that attach the forearm muscles to the elbow. This can include any sudden change in activity level or intensity, or any incorrect grip or grip size in racquet sports.

What is the treatment?

Step 1: Initially, treatment consists of anti-inflammatory medications and a stretching and strengthening program. Stretching is a key component in treating epicondylitis. Hold each stretch for at least 10 seconds, then relax the arm and repeat several times a day and in between activities. (See Figure 2)


Figure 2: Stretching

Strengthening exercises may also help but are not as useful as stretching. You should not experience pain when performing strengthening exercises. Use a light weight and perform at least three sets of 15 to 20 repetitions. (See Figures 3-4)

Figure 3: Wrist Extensors
Figure 4: Supination (left) and Pronation (right)

Step 2: If symptoms continue after a trial of stretching and strengthening, patients may benefit from a cortisone injection. Cortisone acts by decreasing swelling and inflammation, and increasing blood flow to the area which aids in healing. Most patients feel relief after one injection, but up to three cortisone injections over a period of time may be given.

Step 3: If stretching and strengthening, anti-inflammatory medication and cortisone injections do not relieve symptoms, then surgery is beneficial. Through a small incision over the bony prominence on the outside of the elbow the base of the diseased tendon is removed and then normal tendon tissue is repaired back to the bone.
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