Condition Basics

What is tennis elbow?

Tennis elbow, also known as lateral epicondylitis or epicondylopathy, occurs when there is tendon damage at the elbow where some of the forearm and hand muscles connect to the upper arm bone.

What causes it?

Most of the time, tennis elbow is caused by overuse. You probably got it from doing activities where you twist your arm over and over. This can stress the tendon, causing tiny tears that lead to pain over time. A direct blow to the outer elbow can also cause tendon damage.

What are the symptoms?

Tennis elbow causes pain on the outer part of the elbow. The pain usually starts gradually and may go away within 24 hours after an activity. Over time, it may take longer for the pain to go away. You may start to feel pain during everyday activities, like lifting a jug of milk.

How is it diagnosed?

Your doctor will check your elbow and ask questions about the elbow problem, your daily activities, and past injuries. You probably won't need to have an X-ray. But you may need an X-ray or other tests if your symptoms don't get better with treatment.

How is tennis elbow treated?

Most cases of tennis elbow respond to rest, ice, rehab exercises, pain medicine, and using a counterforce brace. You will probably feel better in a few weeks, but it may take 6 to 12 months for the tendon to heal. Surgery is rarely needed.

Prevention

The best way to prevent tennis elbow is to stretch and strengthen your arm muscles so that they are flexible and strong enough for your activities.

Other ways to prevent tennis elbow include:

• Using the correct techniques and movements during activities. If you feel that things you do at work cause elbow pain or soreness, talk to your boss to find other ways to do your job. Also try taking lessons to learn the best way to do a sport.
• Using the best equipment for your ability, body size, and body strength. Have a sports trainer or a person who is familiar with sports equipment check yours to make sure it suits you.
• Not overusing your arm with repeated movements. These can injure your tendon. Try to alternate hands during activities, if possible.
• Strengthening the muscles of your arm, shoulder, and upper back. This can help take stress off of your elbow.

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Symptoms

Tennis elbow symptoms usually start gradually. The main symptom is pain. It may start with a dull aching or soreness on the outer part of the elbow that goes away within 24 hours after an activity. Over time, it may take longer for the pain to go away.

You may start to feel pain with any movement, even during everyday activities, such as lifting a jug of milk. You may even have pain when you aren't using your elbow. Other parts of the arm, shoulder, and neck may also be sore. This is because you are using different movements and muscles to make up for the loss of elbow strength and movement.

When to Call a Doctor

Call your doctor now if you had an injury to your elbow and:

• You have severe elbow pain.
• You cannot move your elbow normally.
• Your elbow looks deformed.
• Your elbow starts to swell within 30 minutes of the injury.
• You have signs of damage to the nerves or blood vessels. These include:
  • Numbness, tingling, or a "pins-and-needles" sensation below the injury.
  • Pale or bluish skin.
  • The injured arm feeling colder to the touch than the uninjured one.

Call your doctor if you have:

• Pain when grasping, twisting, or lifting objects.
• Problems caused by your elbow pain.
• Elbow pain after 2 weeks of home treatment or if treatment is making your elbow pain worse.

Watchful waiting

Watchful waiting is a wait-and-see approach. You and your doctor watch your symptoms to see if your health improves on its own. If it does, no treatment is needed. If your symptoms don't get better or they get worse, then it's time to take the next treatment step.

Home treatment often helps mild tennis elbow pain. You may want to try resting the elbow and applying ice or heat several times a day for 1 to 2 weeks before you call your doctor.

Exams and Tests

To diagnose tennis elbow, a doctor will examine your elbow and ask questions about the elbow problem, your daily activities, and past injuries. You probably won't need to have an X-ray. But you might have one to help rule out other things that could be causing the pain.

If your symptoms don't get better with treatment, you might need other tests.

• An MRI can show problems in soft tissues such as tendons and muscles.
• Arthroscopy allows the doctor to see inside the elbow.
• Bone scans are done in rare cases. They can show stress fractures in the bone or certain problems such as a tumor or infection.

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Treatment Overview

You can start treating tennis elbow at home right away. It includes:

• Reducing pain. You can use ice and over-the-counter medicines. Do this as soon as you notice the pain.
• Stopping or changing activities that may irritate the tendon.
• Using wrist and elbow splints.
• Wearing a special counterforce brace.

With early rest and treatment, an injured tendon is likely to heal with scar tissue and maximum strength.

Most cases of tennis elbow respond to treatment. You will probably feel better in a few weeks, but it may take 6 to 12 months for the tendon to heal.

If your symptoms don't go away, your doctor may suggest:

• A corticosteroid injection. It may help relieve pain for a short time.
• Ultrasound therapy. It may help your tendon heal and stop pain.
• Surgery. But it's seldom used to treat tennis elbow.

Physical rehab for tennis elbow

Physical rehabilitation (rehab) is combined with resting the tendon. It can help restore flexibility and build muscle strength. Rehab helps heal injured tendons and muscles. And it helps prevent further injury. Rehab is also needed after surgery for tennis elbow.

A physical rehab program includes:

• Relieving pain.
• Maintaining good overall physical fitness.
• Exercises. This includes warm-up, stretching, and strengthening exercises.
• Retraining and ergonomic changes at your work site.
• Learning new techniques for certain movements. You can use equipment that best suits your ability, body size, and strength. And you will limit activities that require grasping or twisting arm movements.

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Self-Care

If you have tennis elbow, try these simple tips to reduce pain and start tendon healing. You can help prevent further injury by making your arm muscles stronger.

• Rest your fingers, wrist, and forearm muscles.

  This allows your tendon to heal. Stop any activity that you think may be causing your elbow pain and soreness. You may have to avoid the activity for weeks to months, depending on how severe the tendon damage is.

• Try ice or heat.

  As soon as you notice pain, use ice or cold packs for 10 to 15 minutes at a time, several times a day. Always put a thin cloth between the ice and your skin. Keep using ice as long as it relieves pain. You can try heat, or alternating heat and ice, after the first 3 days. Do what works for you.

• Try using a brace.

  Wear a counterforce brace during activities that require grasping or twisting arm movements. The brace is a strap that you wear around your forearm just below your elbow. It may spread pressure throughout the arm instead of putting it all on the tendon. These braces aren't a substitute for rehab exercises.

• Try elevating your elbow.

  This may help ease pain and reduce swelling in your wrist or forearm.

• Try nonprescription medicine.

  Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin (such as Bayer), ibuprofen (such as Advil), and naproxen (such as Aleve). They help reduce pain and inflammation. NSAIDs come in pills and in a cream that you rub over the sore area. Acetaminophen (such as Tylenol) can also help with pain. Be safe with medicines. Read and follow all instructions on the label.

• Do warm-up and stretching exercises.

  They may help keep your tendons from getting stiff. Examples include finger-thumb opposition and wrist flexor stretches. If you have any pain, stop the exercises.

• Start exercising gradually.

  When your pain is gone, start doing stretching and strengthening exercises. Then increase these exercises bit by bit. Learn the correct techniques and which equipment is best for your activities.

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