The F.A.S.T. Cure for Tennis Elbow (Lateral Epicondylitis)

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. But several other sports and activities can also put you at risk.

Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists, and, in some cases, surgeons work together to provide the most effective care.

Anatomy of the Elbow

Tennis elbow

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.

Muscles, ligaments, and tendons hold the elbow joint together.

Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).

Cause of Tennis Elbow

Overuse

Cause of tennis elbow

Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.

Activities

Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle.

Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.

Age

Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.

Unknown

Lateral epicondylitis can occur without any recognized repetitive injury. This occurence is called “insidious” or of an unknown cause.

The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.

Common Signs and Symptoms of Tennis Elbow

Tennis elbow

• Pain or burning on the outer part of your elbow
• Weak grip strength

The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however both arms can be affected.

Treatments

Tests

Your doctor may recommend additional tests to rule out other causes of your problem.

X-rays

These may be taken to rule out arthritis of the elbow.

Diagnostic Ultrasound

Elbow ultrasound

Using an in-office ultrasound machine, your doctor can quickly diagnosis tennis elbow.

Magnetic Resonance Imaging (MRI)

If your doctor thinks your symptoms are related to a neck problem, an MRI scan may be ordered. This will help your doctor see if you have a possible herniated disk or arthritis in your neck. Both of these conditions often produce arm pain.

Electromyography (EMG)

Your doctor may order an EMG to rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.

Nonsurgical Treatment

Approximately 80% to 95% of patients have success with nonsurgical treatment.

Rest. The first step toward recovery is to give your arm proper rest. This means that you will have to stop participation in sports or heavy work activities for several weeks.

Non-steroidal anti-inflammatory medicines. Drugs like aspirin or ibuprofen reduce pain and swelling.

Equipment check. If you participate in a racquet sport, your doctor may encourage you to have your equipment checked for proper fit. Stiffer racquets and looser-strung racquets often can reduce the stress on the forearm, which means that the forearm muscles do not have to work as hard. If you use an oversized racquet, changing to a smaller head may help prevent symptoms from recurring.

Physical therapy. Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.

Brace. Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons.

Surgical Treatment

If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your doctor may recommend surgery.

Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone.

The right surgical approach for you will depend on a range of factors. These include the scope of your injury, your general health, and your personal needs. Talk with your doctor about the options. Discuss the results your doctor has had, and any risks associated with each procedure.

F.A.S.T. Procedure. The innovative FAST procedure—Focused Aspiration of Scar Tissue—is based on advanced technology developed in collaboration with the Mayo Clinic. FAST is a minimally invasive procedure designed to remove tendon scar tissue quickly and safely, without disturbing your surrounding healthy tendon tissue.

Click here to watch the F.A.S.T procedure.

Arthroscopic surgery. Tennis elbow can also be repaired using tiny instruments and small incisions. Like open surgery, this is a same-day or outpatient procedure.

Surgical risks. As with any surgery, there are risks with tennis elbow surgery. The most common things to consider include:

• Infection
• Nerve and blood vessel damage
• Possible prolonged rehabilitation
• Loss of strength
• Loss of flexibility
• The need for further surgery

Rehabilitation. Following surgery, your arm may be immobilized temporarily with a splint. About 1 week later, the sutures and splint are removed.

After the splint is removed, exercises are started to stretch the elbow and restore flexibility. Light, gradual strengthening exercises are started about 2 months after surgery.

Your doctor will tell you when you can return to athletic activity. This is usually 4 to 6 months after surgery. Tennis elbow surgery is considered successful in 80% to 90% of patients. However, it is not uncommon to see a loss of strength.

Click here for more information.

Tennis Elbow Symptoms, Causes, and Treatments

Written by WebMD Editorial Contributors

In this Article

• The Causes of Tennis Elbow
• Symptoms of Tennis Elbow
• Treatment for Tennis Elbow
• Recovering from Tennis Elbow
• How to Prevent Tennis Elbow

Tennis elbow is a type of tendinitis — swelling of the tendons — that causes pain in the elbow and arm. These tendons are bands of tough tissue that connect the muscles of your lower arm to the bone. Despite its name, you can still get tennis elbow even if you’ve never been near a tennis court. Instead, any repetitive gripping activities, especially if they use the thumb and first two fingers, may contribute to tennis elbow. Tennis elbow is the most common reason that people see their doctors for elbow pain. It can pop up in people of any age, but it’s most common at about age 40.

Tennis elbow usually develops over time. Repetitive motions — like gripping a racket during a swing — can strain the muscles and put too much stress on the tendons. That constant tugging can eventually cause microscopic tears in the tissue.

Tennis elbow might result from:

• Tennis
• Racquetball
• Squash
• Fencing
• Weight lifting

It can also affect people with jobs or hobbies that require repetitive arm movements or gripping such as:

• Carpentry
• Typing
• Painting
• Raking
• Knitting

The symptoms of tennis elbow include pain and tenderness in the bony knob on the outside of your elbow. This knob is where the injured tendons connect to the bone. The pain may also radiate into the upper or lower arm. Although the damage is in the elbow, you’re likely to hurt when doing things with your hands.

Tennis elbow may cause the most pain when you:

• Lift something
• Make a fist or grip an object, such as a tennis racket
• Open a door or shake hands
• Raise your hand or straighten your wrist

Tennis elbow is similar to another condition called golfer’s elbow, which affects the tendons on the inside of the elbow.

To diagnose your tennis elbow, your doctor will do a thorough exam. They will want you to flex your arm, wrist, and elbow to see where it hurts. You may also need imaging tests, such as an X-ray or MRI (magnetic resonance imaging) to diagnose tennis elbow or rule out other problems.

The good news about treatment is that usually tennis elbow will heal on its own. You just need to give your elbow a break and do what you can to speed the healing. Types of treatment that help are:

• Icing the elbow to reduce pain and swelling. Experts recommend doing it for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the pain is gone.
• Using an elbow strap to protect the injured tendon from further strain.
• Taking nonsteroidal anti-inflammatory (NSAIDs), such as ibuprofen, naproxen, or aspirin, to help with pain and swelling. However, these drugs can cause side effects, such as bleeding and ulcers. You should only use them occasionally, unless your doctor says otherwise, since they may delay healing.
• Performing range of motion exercises to reduce stiffness and increase flexibility. Your doctor may recommend that you do them three to five times a day.
• Getting physical therapyto strengthen and stretch the muscles.
• Having injections of steroids or painkillers to temporarily ease some of the swelling and pain around the joint. Studies suggest that steroid injections don’t help in the long term.

Most of the time, these treatments will do the trick. But if you have a severe case of tennis elbow that doesn’t respond to two to four months of conservative treatment, you may need surgery. In the procedure, the damaged section of tendon usually is removed and the remaining tendon repaired. Surgery works in about 85%-90% of cases.

Of course, what you really want to know is when you can get back to your regular activities after having tennis elbow. That depends on your individual case and the extent of the damage to the tendon. People heal at different rates.

Whatever you do, don’t rush your recovery. If you start pushing yourself before your tennis elbow is healed, you could make the damage worse. You are ready to return to your former level of activity when:

• Gripping objects or bearing weight on your arm or elbow is no longer painful.
• Your injured elbow feels as strong as your other elbow.
• Your elbow is no longer swollen.
• You can flex and move the elbow without any trouble.

The key to preventing tennis elbow is to avoid overuse. Stop if you feel any elbow pain during an activity.

You may also bring on tennis elbow by using the wrong equipment, like a golf club or tennis racket that is too heavy or that has a grip that is too large. Bad technique — like using the wrong posture for a swing — can also lead to tennis elbow. You should also:

• Stretch and warm up before any sport or activity that will exercise your elbow or arm.
• Ice your elbow after exercise.

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Treatment of epicondylitis of the elbow joint (tennis elbow) in Yaroslavl

Description

If at rest there is no pain in the elbow joint, and it occurs during palpation of the external epicondyle during certain movements – extension and internal rotation (supination) of the forearm, and especially with a combination of these movements, then these are signs of the so-called “tennis elbow” or ” epicondylitis” . The scientific name for this syndrome is “lateral epicondylitis” . Curiously, most tennis elbow patients do not play tennis at all.

Pronation-inward rotation of the forearm inward and its flexion, supination-rotation of the forearm outward and passive extension are usually painless, pain appears only with resistance. When squeezing the hand into a fist with simultaneous flexion in the wrist joint, the pain intensifies.

Usually the pain is progressive in nature, even the slightest movements made with the participation of the affected tendons become painful. On palpation in the area of ​​the external epicondyle, there is severe pain, and pain limitation of passive movements is determined, which are carried out with the patient’s resistance (supination, flexion, half-pronation of the forearm). With dynamometry, the strength of the hand is sharply reduced. With a long course of epicondylitis, ossification of the tendons near the external epicondyle is determined radiographically.

Causes of disease

Speaking about the causes of the disease, it is worth noting the problems of adaptation of the connective tissue to modern industrial and domestic loads. The mechanism of development of epicondylitis is associated with a strong tension of the tendons of the extensor muscles, the supinator (the muscle that rotates the hand outward) and the pronator (the muscle that rotates the hand inward). In addition, the cause of the disease can be an injury, awkward or repeated without the necessary rest, or performed with excessive effort of hand movements. It can be long flexion of the wrist, long rotation of the forearm, punches, throws. As a result, microtears occur in the tendons that attach the extensor muscles of the forearm to the humerus. Just the cause of acute and chronic pain is inflammation of the attachments of the muscle to the bone.

The course of epicondylitis is chronic. Under the condition of relative rest and correct, after a few weeks (sometimes months) the pain subsides and recovery occurs. But the disease can recur when returning to physical labor.

Treatment

Treatment of epicondylitis conservative

It is recommended to eliminate the load on the affected limb, the use of fixing bandages on the elbow joint. Massage is prescribed for the relief of an acute process. We do not advocate local administration of steroid drugs.

Alternative minimally invasive treatment

This is a method of cold plasma ablation, which is carried out through a small puncture of the skin.

Tennis elbow surgery

Represents the separation of the extensor attachment site from the external epicondyle of the shoulder.

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