Lateral epicondylosis, commonly known as tennis elbow or lateral epicondylitis, is a condition involving the tendons attached to the bony prominence on the outside of the elbow called the lateral epicondyle.
The tendon most commonly affected in lateral epicondylosis is the anchor of a muscle called the extensor carpi radialis brevis (ECRB). The ECRB muscle extends the wrist and stabilizes the wrist during activities involving grip.
In lateral epicondylosis, degenerative changes develop in the tendon. This “wear and tear” increases stress on the tendon, causing pain during activities when the ECRB muscle is active – such as lifting, gripping, and/or reaching for and grasping items.
Causes of Tennis Elbow
Tennis elbow is most commonly seen in non-athletes between the ages of 35-55 years of age. It can be caused by a single event (trauma) or repetitive stress (overuse).
For an athlete, a change in equipment, mechanics, or intensity of play or practice can cause symptoms.
Research studies have shown there is no relationship between computer use and developing lateral epicondylosis. This condition does not occur in children.
- Pain at or around the lateral elbow
- Often very tender to touch over the lateral epicondyle
- Pain may radiate up or down the arm
- Pain may worsen when reaching, gripping or lifting objects
- Occasionally, the elbow may be stiff or swollen - especially in the mornings
The doctor may recommend limiting the activity or activities that cause pain, not total rest. Stay as active as possible, while avoiding things that increase pain. Modifying equipment, changing body mechanics, or using ergonomic tools may help decrease symptoms.
Anti-inflammatory medications such as aspirin, ibuprofen (Advil), acetaminophen (Tylenol) or naproxen (Aleve) may help alleviate pain.
A wrist splint may be worn to rest the muscles affected by tennis elbow. A tennis elbow brace, a band worn around the muscles of the forearm just below the elbow may reduce the tension on the tendon and decrease pain, but should only be used during activity that causes pain at the elbow. Proper application of this brace is key to its effectiveness.
Options include steroid injections, platelet-rich plasma (PRP), or autologus blood injection (ABI). Discuss the risks and benefits of injection with your provider. Injections to the affected portion of the elbow can provide short-term pain relief and reduced inflammation in the joint, when medication is ineffective or not an option.
Hand therapists use education, splinting, and exercises for stretching and strengthening to help you learn to manage your symptoms. Therapists sometimes use different modalities, such as ultrasound or soft tissue mobilization to help reduce pain.
Surgery is considered only when persistent pain and disability are present despite 6-12 months of non-operative management. A consultation with your provider will help decide the best course of treatment for your injury.