Lateral Epicondylitis (Tennis Elbow)

Lateral epicondylitis, also known as tennis elbow, is a condition characterized by pain and tenderness around the outside of the elbow joint. It occurs when tiny tears form in the tendons that attach to the bony bump on the elbow (lateral epicondyle). This causes inflammation and pain when bending your arm or twisting your wrist. It is most commonly seen in athletes and people who do repetitive arm movements, but it can also be caused by everyday activities such as gardening, manual labor or even typing.

The part of the muscle that attaches to a bone is called a tendon. Some of the muscles in your forearm attach to the bone outside your elbow. When you use these muscles repeatedly, small tears may develop in the tendon. Over time, the tendon cannot heal, leading to irritation and pain where the tendon is attached to the bone.

In most cases, lateral epicondylitis is caused by repetitive forearm movements that strain the tendons around the elbow joint. However, it can also be caused by an injury or trauma to the elbow, such as a direct blow or fall. Any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to this condition. Painters, plumbers, construction workers, cooks and butchers are professionals who are more likely to develop tennis elbow.

The most common risk factors for lateral epicondylitis include repetitive motions, certain sports and some occupations. Athletes who play racket sports, such as tennis, squash or racquetball, are more likely to develop this condition, particularly if they use poor form. 

Individuals who work in professions that involve heavy physical exertion, elbow flexion and extension, or repetitive motions (such as painters, plumbers and construction workers) are at higher risk of developing lateral epicondylitis.

To prevent lateral epicondylitis, it is important to practice proper form when engaging in activities that require repetitive arm movements. Taking frequent breaks and avoiding overuse of elbow joints can also help reduce the risk of developing this condition.

Additionally, wearing protective equipment, stretching before and after activities and warming up can help prevent tennis elbow. Remember not to “play through the pain.” Stop and rest if you experience any symptoms during high-risk activities.

The primary symptom of lateral epicondylitis is a dull ache that radiates from the outside of the elbow to the forearm and wrist. This ache can worsen with activities such as lifting, gripping or shaking hands. Other symptoms may include tenderness to the touch and weak grip strength.

Symptoms can include any of the following:

• Elbow pain that gets worse over time
• Pain that radiates from the outside of the elbow to the forearm and back of the hand when grasping or twisting
• Weak grip

To diagnose lateral epicondylitis, your doctor may perform a physical exam and take a medical history to determine the cause of your symptoms. Imaging tests, such as an X-ray or magnetic resonance imaging (MRI) scan, may also be necessary to confirm a diagnosis.

During the physical exam, your provider will look for signs of pain and tenderness during specific movements. They will examine your elbow joint closely, looking for swelling, tenderness, reduced range of motion and muscle weakness.

The first step to treat lateral epicondylitis is to rest your arm for two to three weeks and avoid or modify the activity that causes your symptoms. Here are some additional steps you can take:

• Ice the outside of your elbow two or three times a day. Cover the painful area with a towel and apply the ice for 15 minutes.
• Take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen or aspirin. 

Whether your tennis elbow is due to sports activity or your occupation, you may want to:

• Ask your provider about any changes you can make to your technique.
• Check your sports equipment to see if any changes may help. For example, if you play tennis, changing the grip size of the racket may help.
• Consider how often you play and whether you should cut back or cross-train.
• Work with a Montefiore Einstein Department of Physical Medicine and Rehabilitation physical therapist who can show you exercises to stretch and strengthen your forearm muscles.
• You can buy a special brace (counter-force brace) for tennis elbow at a drugstore. This brace wraps around the upper part of your forearm and relieves some of the pressure on the muscles.
• Your provider 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.
• Use non-opioid oral pain management.
• If your symptoms are related to working on a computer, ask your manager about changing your workstation or your chair, desk and computer setup. For example, a wrist support or a roller mouse may help.

Surgery to repair or remove the injured tendon may be recommended if the pain continues after rest and treatment. Talk with your orthopedic surgeon about the risks and whether surgery might help.

Most elbow pain gets better without surgery. However, most people with surgery fully use their forearm and elbow afterward. Contact your provider for an appointment if this is the first time you have had these symptoms and home treatment does not relieve them.