Tennis elbow

• Alternative Names

  Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral

• Causes, incidence, and risk factors

  This injury is due to repeated motions of the wrist or forearm. The injury is typically associated with tennis playing, hence the name "tennis elbow." However, any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to this condition.

• Symptoms
  • Elbow pain that gradually worsens
  • Pain radiating from the outside of the elbow to the forearm and back of the hand when grasping or twisting
  • Weak grasp
• Signs and tests

  The diagnosis is made based on signs and symptoms, since x-rays are usually normal. Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow

  There is also pain near the elbow when the wrist is extended (bent backwards, like revving a motorcycle engine) against resistance.

• Treatment

  The goal of treatment is to relieve pain and swelling. Treatment may include:

  • Heat therapy
  • Local injection of cortisone and an numbing medicine
  • Nonsteroidal anti-inflammatory medications (such as ibuprofen, naproxen or aspirin)
  • Physical therapy
  • Pulsed ultrasound to break up scar tissue, promote healing, and increase blood flow in the area
  • Using a splint to keep the forearm and elbow still for 2 to 3 weeks

  To prevent the injury from happening again, a splint may be worn during activities that aggravate the condition. Or, you may need to limit certain activities. If the pain persists despite non-surgical treatments, surgery may be necessary.

• Expectations (prognosis)

  Most people improve with non-surgical treatment. The majority of those who do have surgery show an improvement in symptoms.

• Complications
  • Failure to improve with nonsurgical or surgical treatment. This may be due to nerve entrapment in the forearm
  • Recurrence of the injury with overuse
  • Rupture of the tendon with repeated steroid injections
• Calling your health care provider

  Apply home treatment (over-the-counter anti-inflammatory analgesics and immobilization) if symptoms are mild or if you have had this disorder before and you know this is what you have.

  Call for an appointment with your health care provider if this is the first time you have had these symptoms, or if home treatment does not relieve the symptoms.

• Prevention

  Maintain good strength and flexibility in the arm muscles or avoid repetitive motions. Rest the elbow when flexion and extension (bending and straightening) are painful. An ice pack applied to the outside of the elbow after repetitive motion may help alleviate symptoms.

• References

  Biundo JJ. Bursitis, tendinitis, and other periarticular disorders, and sports medicine. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 284.

  Geiderman JM. Humerus and elbow. In: Marx, JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006: chap 49.

  Johnson GW, Cadwallader K, Scheffel SB, et al. Treatment of Lateral epicondylitis. Am Fam Physician. 2007;76(6):843-8.

Review Date: 8/11/2008

Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Maternal & Child Health Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.