What is tennis elbow (lateral epicondylitis)?

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Tennis elbow (lateral epicondylitis) is a medical condition that is characterized by inflammation of the tendons of the forearm and the outside of the elbow. It is typically caused by overuse of the forearm and results in pain and other symptoms. The term tennis elbow is somewhat misleading. While the name suggests that playing tennis causes this condition, many other activities can lead to tennis elbow. These activities usually involve repetitive motion. Treatment for tennis elbow may include icing the affected area, taking medication, or receiving steroid injections. Some patients may require surgery, which is followed by a period of rehabilitation.

Cause

Tennis elbow is usually caused by repetitive strenuous use of the forearm. Certain activities, like playing tennis, can contribute to the condition. Tennis players are especially susceptible to the condition if they use poor techniques or improper equipment. For example, an individual who has a poor backhand technique may develop tennis elbow. Racquetball and squash are two other sports that can lead to tennis elbow. The condition can also be caused by other repetitive activities, particularly ones that involve twisting or gripping with the hands. Such activities include painting, using a screwdriver, cutting meat, and pruning bushes. Therefore, painters, carpenters, butchers, and professional gardeners are at risk of developing tennis elbow.

The forearm has a muscle called the extensor carpi radialis brevis (ECRB). If the ECRB becomes damaged, tennis elbow may result. Damage to the ECRB typically occurs when the muscle is overworked and small tears develop in a tendon that connects the ECRB to the lateral epicondyle, or the bony prominence on the outside of the elbow. Inflammation of the area often results from this damage.

Symptoms

Tennis elbow causes several symptoms that develop slowly. Pain on the outside of the elbow is the most common symptom, and it usually worsens over time. The pain may spread to the forearm and wrist. People with tennis elbow sometimes experience a burning sensation and tenderness in the area and may have weak grip strength. Someone with tennis elbow may find it difficult to hold a cup, turn a doorknob, turn a key, shake hands, or perform similar simple tasks.

Diagnosis

Tennis elbow is diagnosed during a medical examination. The doctor will give the patient a physical exam and take a medical history. The patient will be asked to move his or her arm, wrist, and fingers in different directions. The doctor will also ask the patient which activities cause pain or other symptoms. Based on the physical exam and medical history, the doctor can usually diagnose the patient with tennis elbow. Sometimes, additional tests are needed to rule out other problems. For example, X-rays can determine whether the patient has arthritis of the elbow. Because neck problems such as a herniated disk or arthritis can cause pain in the arm, a magnetic resonance imaging (MRI) test may be needed to rule out other issues. Furthermore, an electromyography (EMG) can reveal if the patient has nerve compression, which is a condition that results in symptoms similar to tennis elbow.

Treatment

Treatment for tennis elbow is not always necessary, as the condition often goes away on its own. For people who do need treatment, several options are available. The simplest form of treatment is rest. The patient should not subject the affected arm to any strenuous activity. This includes participating in sports and performing difficult work tasks. People who have developed tennis elbow from playing a sport should evaluate their equipment and playing techniques to determine whether any adjustments should be made to ease stress on the arm.

Icing the affected area for fifteen minutes several times a day is another simple form of treatment. Physicians may also advise patients with tennis elbow to take over-the-counter pain medications—such as aspirin, ibuprofen, or naproxen—to reduce pain and inflammation. In addition, wearing an orthotic (such as a strap, brace, band, or splint) may be helpful for some people.

Tennis elbow is sometimes treated with steroid injections. A doctor will inject the affected muscle with an anti-inflammatory steroid, such as cortisone. Some patients may also require physical therapy, which often includes exercises that help strengthen the forearm and promote muscle healing. Some doctors may recommend shock wave therapy to treat tennis elbow, but this treatment option is not common. Shock wave therapy involves sending sound waves to the elbow to help with the healing process.

Up to 95 percent of people with tennis elbow respond positively to these treatments. However, if a patient does not see any improvement after six to twelve months of treatment, surgery may be necessary. Typically, tennis elbow surgery involves removing damaged muscle and reconnecting undamaged muscle to bone. Two main surgical approaches are available: open surgery and arthroscopic surgery. In open surgery, the surgeon makes an incision over the elbow. In arthroscopic surgery, the surgeon makes several smaller incisions. Following surgery, the patient may need to wear a splint that immobilizes the arm for about a week. After the splint is removed, the patient can begin performing rehabilitation exercises. Tennis elbow surgery has an 80 to 90 percent success rate.

Bibliography

Mayo Clinic Staff. "Tennis Elbow." Mayo Clinic. Mayo Foundation for Medical Education and Research. 29 June 2013. Web. 26 Mar. 2015. http://www.mayoclinic.org/diseases-conditions/tennis-elbow/basics/definition/con-20043041

"Tennis Elbow (Lateral Epicondylitis)." OrthoInfo. American Academy of Orthopaedic Surgeons. Web. 26 Mar. 2015. http://orthoinfo.aaos.org/topic.cfm?topic=a00068

"What to Do about Tennis Elbow." Harvard Health Publications. Harvard University. 1 May 2007. Web. 26 Mar. 2015. http://www.health.harvard.edu/diseases-and-conditions/what-to-do-about-tennis-elbow

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