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Tennis elbow, more formally known as lateral epicondylitis, is a very common condition. It is a degenerative tendonitis, meaning that a specific group of tendons starts to wear as a result of repetitive use. This repetitive use results from normal daily activities in most cases, but may be aggravated by the activities of some jobs or some avocations. Playing tennis itself can be an aggravating factor, but tennis players make up only a small percentage of individuals who develop tennis elbow.

Why someone develops tennis elbow is most probably a combination of factors: what they do, how they do it, and their individual anatomy. Pain is the predominant feature of this condition, and is generally made worse with activity. It is located on the outside, or lateral, aspect of the elbow, but can radiate up or down the arm. This condition is not associated with numbness or tingling.

The process usually starts with small, microscopic tears in the tendons as they originate off the bone of the lateral epicondyle. An inflammatory response occurs, and there is edema and bleeding in the area. Eventually, scar tissue forms. Treatment is directed to stop the cycle of repeated tendon wear.

Conservative measures are usually employed first. The include the following measures:

Rest from the offending activity. If a sport such as tennis is involved, then a period of rest is indicated. If a work activity is causative, then work restrictions may be required to avoid the most aggravating activity.

Wear of a forearm strap. This device is designed to change the site of muscle tension from the bone of the lateral epicondyle to an area over the muscle just below it. It has been shown by intricate electrical studies to actually accomplish that transfer. It reduces symptoms in all most all patients, and is worn primarily when active. This may be while the individual is at work, sport, or engaged in home activities that require frequent gripping, grasping, or wrist motion.

Wear of a wrist splint. This may be worn with or without the forearm strap. It helps to rest one of the wrist extensor tendons most often involved. It is also used primarily while active.

The use of ice. Ice or cold packs can greatly reduce the amount of inflammatory response, and should be applied to the lateral epicondylar area for 5 to 10 minutes. It is most effective immediately after work, sport or other activities that utilize the involved tendons.

The use of moist heat. Heat is more effective when used either before activity, or sometime well after the activity.

Anti-inflammatory medications may be of some benefit. There are many available, including advil, ibuprofen, and motrin. Compounds such as Tylenol do not possess this anti-inflammatory property. All medications have possible side effects, including anti-inflammatory medications. The most common side effect here is irritation of the stomach, even leading up to ulcers. Whenever possible, these medications should be taken for specified time periods such as 2 to 3 weeks, and with milk or food. Prescription medications are more expensive, but may be less irritating to the stomach and can usually be taken on a less frequent basis such as once or twice a day.

Lifting modifications. Lifting with the "palm-down" utilizes the tendons involved in this condition, so changing lifting patterns to "palm-up" when possible will utilize a different group of tendons coming from a different part of the elbow. Changing racquet techniques, altering tools, and more frequent rotation of job activities can all be helpful factors.
Lifestyle changes- changes in the way work or activities are conducted, may be the most important aspect of treating this condition. Once the initial pain is reduced, rehabilitation can be started. This begins with wrist stretching exercises and isometric strengthening exercises. Progressive strengthening can be added, and this can be facilitated by a therapist. Most studies indicate failures of treatment usually involve resuming causative activity without change.

These measures supply adequate relief for the majority of patients. If they are not adequate, other options are available to include supervised therapy, cortisone injection, or casting:

CORTISONE INJECTION: Cortisone injections are given to reduce inflammation and pain. This is a temporary measure that decreases symptoms while the body is in the process of healing. Up to three cortisone injections can be given. Other conservative measures, as listed above, should be employed in conjunction with the cortisone shot. The risks of cortisone shot include a small risk of infection, a small risk of allergic reaction, and a small risk of depigmenting the skin adjacent to the injection.

SUPERVISED THERAPY: A therapist can be beneficial by teaching stretching and eventual strengthening exercises, and in teaching alternative ways to accomplish activities. A therapist can also employ modalities such as electrical stimulation, ultrasound, or administering cortisone through ultrasound (iontophoresis,) that may decrease pain.

CASTING: applying a cast for 4 weeks to fully immobilize the elbow is a rarely employed alternative. It enforces rest to allow the elbow a head start toward healing. Once removed, conservative measures must be employed.

SURGERY: For those few patients who develop chronic pain that remains unresponsive to the above measures, surgery can be considered. Conservative measures should be used at least 6 months before considering surgery. Lifestyle changes must be used afterwards, or symptoms are likely to recur if activity is not altered from before surgery. The results of surgery are not as predictable as for many other surgeries. Surgery is done to remove degenerated tendon tissue.

MEDIAL EPICONDYLITIS: A similar degenerative tendonitis can occur on the medial, or inside, , aspect of the elbow. This is sometimes called golfer's elbow. This condition occurs much less commonly than tennis elbow, but the treatment measures differ in only small ways: the forearm strap is worn so that the pad is on the medial (inside) aspect of the forearm, and lifting modifications include trying to lift with the palm down instead of up. All other measures as listed for tennis elbow are identical. As with tennis elbow, most patients eventually resolve the problem without the need for surgery.