Tennis Elbow? But I Don’t Even Own a Racquet!
Robert J. Snyder, M.D.
The term “tennis elbow” is misleading because most times a diagnosis is not related to leisure or sports activities. Tennis elbow presents when patients overwork the tendons with repetitive motions of the wrist and arm. Patients who often suffer from this condition are those whose jobs require repetitive movements such as painters, plumbers, butchers, and carpenters. Playing tennis, especially when repeatedly using improper technique, can also cause tennis elbow, but I see it in more often in non-athletes.
Causes
Tennis elbow or lateral epicondylitis of the elbow using the anatomically correct diagnosis is a painful condition caused by injured or damaged tendons near the elbow. It is considered an overuse or muscle strain injury. When you repeat a particular motion, the forearm muscles are repeatedly contracted. Gripping, twisting and reaching can become hazardous when they are done with excessive force, in an awkward position, or with constant repetition. The tendons can be overloaded if you make repeated strong, quick movements, and they can begin to become frayed like a rope. This cause very tiny tears and degenerative changes at the attachment site to the lateral epicondylar area of the elbow. Tendons degenerate or become inflamed and can cause pain in a number of places on the arm: right above the elbow joint, forearm, elbow, wrist, or on the outer side of the arm. (When the damaged tendons and pain happen on the inside of the arm, it is called “golfer’s elbow.”)
Signs and Symptoms
You may experience weakness or pain that makes it difficult to do everyday movements such as holding a coffee cup or turning a doorknob. Pain may radiate when you move in certain ways, such as straightening the elbow while bending the wrist, straightening the fingers against resistance, or straightening the elbow and bending the hand back against resistance. When I exam a patient, pain in these ways can be indicative of tennis elbow. It can present in a patient in a few different ways. Some patients develop it suddenly soon after beginning a new type of work. Some will feel the symptoms gradually worsen over many years of the same type of movement. Others will develop it immediately after an injury or violent muscle strain.
Treatment Options
It can be frustrating to be uncomfortable, so if you think you have Tennis Elbow, you should begin a regimen of self-care to ease the pain and tenderness. Most importantly, I recommend rest from the activity that is causing elbow pain. Also important is ice and non-steroidal anti-inflammatories such as Ibuprofen (Advil) or Naproxen (Aleve). Tennis elbow is often relieved with watchful waiting – if you change or avoid the activity or movement causing the pain, you are likely to feel much better.
If you do not feel better with self-care, you should visit a sports medicine or orthopaedic physician who can recommend next steps to you because if you choose not to treat it, tennis elbow may result in chronic pain. The next steps would be an ultrasound guided cortisone injection to reduce inflammation and speed the healing process. I will also recommend physical therapy. A therapist will assess your condition and work with you to restore your elbow to its highest level of function. Very rarely does a patient require surgery for tennis elbow. If symptoms persist after injections and therapy surgery may be indicated. Traditional surgeries involve debriding the abnormal degenerative tissue or using an instrument that places tiny holes in a grid around the damaged tissue to allow the patient’s own vascular supply to grow into and heal the affected area (Topaz Procedure).
Prevention
We cannot advise you to change your profession, but we can provide you with information to try and prevent injury:
- The most important thing is to be aware of this disorder and what can cause it.
- You should also address risk factors and eliminate them before you develop the condition.
- Be sure to take breaks often, even if it’s just for 60 seconds to stretch your wrist, fingers, and elbows. Change positions often and rest certain body parts when you can.
- Arrange workstations properly with an ergonomic specialist to avoid injury
- Use smooth movements instead of quick, jerky ones
Tennis elbow is often successfully treated with rest, ice, and anti-inflammatories. If you do not successfully alleviate symptoms with self-care, please make an appointment to see me and I will recommend next steps to you.
Robert J. Snyder, MD is a board-certified Orthopaedic Specialist with Orthopaedic & Spine Center in Newport News, Virginia. Named a Top Doc for 2012 and 2013 by a survey of Hampton Roads Physicians, Dr. Snyder’s practice is focused primarily on sports-related injuries and disorders, and on total and partial joint replacements of the hip and knee, including the Conformis knee replacement system. Call 757-596-1900 to make an appointment. Visit www.osc-ortho.com to learn more about OSC and Dr. Snyder.