Seattle Tennis Elbow Treatment

Tennis Elbow Overview

Tennis elbow is one of several overuse injuries that can affect your elbow. Other similar conditions include golfer′s elbow and little leaguer′s elbow – but they involve a different part of your elbow.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to the bony prominence on the outside of your elbow (lateral epicondyle). Pain can also spread (radiate) into your forearm and wrist. Another name for tennis elbow is lateral epicondylitis. The bony spot where pain occurs is near the lower end of the humerus, the bone that connects your shoulder to your forearm at the elbow.

By contrast, both the pain of golfer's elbow and the pain of little leaguer's elbow occur at the bony prominence on the inside of your elbow (medial epicondyle). These conditions also go by the name medial epicondylitis.

Although playing tennis is one cause of tennis elbow, many other common activities can cause the condition. Treatments commonly involve rest and use of anti-inflammatory medications. Rarely, surgery is an option.

Signs and symptoms of tennis elbow may include:

Pain that radiates from the outside of your elbow into your forearm and wrist
Pain when you touch or bump the outside of your elbow
A weak grip
A painful grip during certain activities, such as shaking hands or twisting a doorknob
Pain when you extend your wrist

You also may feel pain even when you aren't moving your arm.

Causes of Tennis Elbow

Tennis elbow is an overuse injury, involving repeated contraction of the forearm muscles that straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in inflammation or a series of tiny tears of the tendons that attach the forearm muscles to the bone at the outside of your elbow.

As the name tennis elbow indicates, playing tennis– particularly, repeated use of the backhand stroke with poor technique – is one possible cause of the condition. However, quite a wide range of common arm motions can result in tennis elbow. These activities may include using a screwdriver, hammering, painting and others.

When to seek medical care for Tennis Elbow

If self-care steps such as rest, ice and use of over-the-counter pain relievers don't result in improvement of your symptoms within a week or so, see your doctor to rule out other complications.

Seek medical care immediately if:

Your elbow is hot and inflamed, and you have a fever.
You can't bend your elbow at all, or it looks deformed.
You've had a fall or injury that makes you wonder if a bone is broken.

Complications

Left untreated, tennis elbow can result in chronic pain. You may find the pain restricts your motion, and you may have pain when lifting or gripping objects or when opening doors. Avoiding using your arm in certain ways can lead to loss of some of the function of your arm. In addition, overusing the arm again before it has healed can result in a worse injury.

Treatment for Tennis Elbow

Initial treatment of tennis elbow usually involves self-care steps including rest, icing the area and use of acetaminophen (Tylenol, others) or over-the-counter (OTC) anti-inflammatory medications, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others). If those steps don't help and you still have pain and limited motion after a week or so, your doctor may suggest other steps. These may include:

Analyzing the way you use your arm at work or at play. Your doctor may suggest that experts evaluate your tennis technique or job tasks to determine the best steps to reduce stress on your injured tissue. This may mean going to a two-handed backhand in tennis or taking ergonomic steps at work to ensure that the way you use your wrist and forearm doesn't continue to contribute to your symptoms.
Exercises. Your doctor – or physical therapist to whom you've been referred by your doctor – may suggest exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm. Once you've learned these exercises, you can do them at home or at work. Your doctor may also suggest you wear straps or braces to reduce stress on the injured tissue.
Corticosteroids. If your pain is severe and persistent, your doctor may suggest an injection of a corticosteroid medication. Corticosteroids are drugs that help to reduce pain, swelling and inflammation. Injectable corticosteroids rarely cause serious side effects, although they may temporarily raise blood sugar levels in people with diabetes. However, these medications don't provide a clear long-term benefit over physical therapy exercises or taking a wait and see approach and simply resting your arm. Your doctor may also suggest use of topical corticosteroids for pain relief. These corticosteroids are absorbed through your skin during a treatment called iontophoresis, which involves drawing the medication into the tissue through electrical charges.
Surgery. If other approaches haven't relieved your pain, if you've been faithful with your rehabilitation program and given it enough time, and if the activity of your arm is still restricted, your doctor may suggest surgery. Only about one in 10 people with tennis elbow need surgery. You'll be able to have the surgery done on an outpatient basis, meaning you can go home the same day. Surgery involves either trimming the inflamed tendon, or surgically releasing and then reattaching the tendon to relieve pain. Other treatments for tennis elbow are being investigated. Some treatments being studied include low-energy shock wave treatment and treatment

Tennis Elbow Prevention

These steps may help you prevent a tennis elbow injury:

Review your technique. Have a tennis professional review your technique to see if you're using the proper motion. Swing the racket with your whole arm and get your entire body involved in the stroke, not just your wrist. Keep your wrist rigid during ball contact. Also, make sure you have the proper racket grip size and string tension. Lower string tension of around 55 pounds transmits less force up to the elbow.
Build your strength. Prepare for any sport season with appropriate preseason conditioning. Do strengthening exercises with a hand weight by flexing and extending your wrists. Letting the weight down slowly after extending your wrist is one way of building strength so that force is absorbed into your tissue.
Keep your wrist straight. During any lifting activity – including weight training – or during tennis strokes, try to keep your wrist straight and rigid. Let the bigger, more powerful muscles of your upper arm do more of the work than your smaller forearm muscles do.
Warm up properly. Gently stretch the forearm muscles at your wrist before and after use.
Use ice. After heavy use of your arm, try applying an ice pack or use ice massage.

Edwin D. Vyhmeister MD, C. Hendrik Kirchhoff MD and Harold J. Kirkpatrick MD - Providing services in hand and wrist injury surgery, tennis elbow and shoulder therapy and tendinitis treatment to the areas of Everett and Seattle, Washington.