Lateral Epicondylitis (Tennis Elbow)

What is it?

Lateral epicondylitis (tennis elbow) is a condition in which the bony bump on the outside of the elbow becomes painful and tender. The elbow joint is made up of the humerus bone in the upper arm and the ulna in the lower arm. The bony bumps at the bottom of the humerus are called epicondyles; and the bump on the outer side of the elbow, to which certain forearm muscles are attached by tendons, is called the lateral epicondyle. Lateral epicondylitis is also referred to as wrist extensor tendonitis. Lateral epicondylitis is associated with pain occurring when you straighten or raise your wrist, make a fist, grip objects, or turn a door handle as well as with pain that shoots from the elbow down into the forearm or up into the upper arm.

Your doctor will perform a physical examination and may order x-rays in order to properly diagnose lateral epicondylitis.

What are the treatment options?

Treatment may include any of the following:

• Icing the elbow for 20-30 minutes every few hours 
• Ice massage 
• Seeing an occupational therapist and receiving exercises to perform 
• Anti-inflammatory medication 
• Use of a tennis elbow strap which acts to keep the forearm muscles from pulling on their attachment site on the epicondyle 
• Avoiding repetitive motion of the elbow 
• Corticosteroid injection 
• Iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine into the sore area.

Risk Factors

Repetitive overuse of the muscles that straighten and raise your hand in the wrist and forearm is a risk factor for developing lateral epicondylitis. When these muscles are overused, the tendons repeatedly tug at their point of attachment on the lateral epicondyle. As a result, the tendons become inflamed. Activities often associated with lateral epicondylitis include: tennis, racquet sports, carpentry, machine work, typing and knitting.

Rehabilitation Plan - Exercises

The goal of rehabilitation is to return you to your sport or activity as soon as it is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate so return to your sport or activity will be determined by how soon your elbow recovers and not by how many days or weeks it has been. The following rehabilitation plan will be used.

Phase 1- Managing Pain and Promoting Healing

• Wear the elbow band at all times to decrease pain 
• Perform massage to the surrounding area two times a day. The massage will help enhance circulation, promote healing and dampen the pain. 
• Apply moist heat to the elbow for 10 minutes two times a day. The moist heat will promote soft tissue healing and increase the flexibility of the muscles surrounding your elbow.

Phase 2- Restoring Flexibility: Active Stretching Exercises

Exercises performed in specific positions are recommended to gradually stretch or elongate the muscle-tendon fibers surrounding the elbow that may have lost some flexibility. This will help reduce the discomfort you are experiencing and restore flexibility to the muscles

• Before beginning apply moist heat to the elbow for 10 minutes to promote soft tissue healing and increase the flexibility of the muscles surrounding the elbow.

• Perform the following active stretching exercises two times a day for 10 repetitions.
     o Actively position the wrist in flexion to a count of 15 before resting and repeat. Do not progress to the next exercise until the exercise can be completed without pain.
     o With your elbow bent, bend your wrist toward your body 
     o With your elbow bent and palm down, bend your wrist toward the floor 
     o With the elbow straight, forearm neutral, bend your wrist toward your body 
     o With your elbow straight and palm down, bend your wrist toward the floor