Tennis Elbow

Tennis elbow is pain on the outside of the elbow from overuse of the tendons that anchor the wrist-extensor muscles to the bone. Despite the name, most people who get it have never played tennis, and despite the medical term epicondylitis, the problem is not mainly inflammation. It is tendon degeneration: the tendon fibers at the attachment partially break down and lose their normal structure. Because the problem is degeneration rather than active inflammation, rest alone rarely resolves it, and the tendon needs gradual loading to remodel and rebuild.

Common symptoms include:

• Pain over the bony bump on the outside of the elbow, often spreading into the forearm
• Pain when gripping, twisting a doorknob, shaking hands, or lifting with the palm down
• A weaker grip, with trouble holding a mug or opening a jar
• Tenderness to press on the outer elbow and pain when the wrist is extended against resistance

Tennis elbow is usually diagnosed from the history and a focused exam, with tenderness on the outer elbow that worsens when gripping or resisting wrist extension. X-rays are usually normal and not needed in a typical case. When imaging is ordered, ultrasound or MRI can show the thickened, degenerated tendon at its attachment.

Care begins without surgery, and most people recover this way over several months:

• Activity changes to reduce the gripping and twisting that drive the pain
• A counterforce brace worn around the upper forearm to absorb load on the tendon
• Physical therapy with eccentric wrist exercises and grip strengthening, the most effective long-term treatment
• Anti-inflammatory medication, oral or topical, for short-term relief during a flare
• A corticosteroid injection used sparingly for fast short-term relief, which does not change the underlying tendon

Surgery is reserved for a small number of people with persistent, disabling symptoms after a thorough trial of nonsurgical care. The procedure removes the degenerated portion of the tendon at its attachment.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Tennis Elbow (Lateral Epicondylitis) — AAOS OrthoInfo