1. Know the Signs
Tennis elbow (lateral epicondylitis) is an overuse injury caused by degeneration of the tendon fibers that attach to the bony prominence (epicondyle) on the outside (lateral side) of the elbow. These tendons are attached to the muscles that extend or lift the wrist and hand, so pain can extend from your elbow into your forearm and wrist.
Golfer's elbow (medial epicondylitis) is similar to tennis elbow except that golfer's elbow occurs on the inside (medial side) of your elbow. It occurs less commonly. However, tennis players who place a lot of topspin on their forehands can develop this condition.
2. Analyze Your Activities
Activities that require repetitive and vigorous use of the forearm muscles may lead to tendon tears. As you might guess, playing tennis is one cause, but many other common activities can cause tennis elbow as well---both recreational (racquetball, squash and fencing) and occupational (meat cutting, hammering, painting, raking and weaving). Most patients, however, develop tennis elbow without any specific cause. In these cases, the tendon degeneration is thought to be a result of aging or a lack of good blood flow to the area. Once the tendon is injured or degenerated, abnormal tissue (angiofibroblastic dysplasia) prevents the tendon from healing.
3. Check the Symptoms
Tennis elbow happens mostly in patients between 30 and 60 years of age, equally in both genders, and 60 to 75 percent of the time in the dominant arm. Patients complain of pain directly over the lateral portion of their elbow. Pain is heightened by pressing on the outside of the elbow, by extending the wrist and by gripping or lifting objects. Even shaking hands or turning doorknobs can lead to significant discomfort.
4. Get It Diagnosed
The diagnosis of tennis elbow involves a physical examination your elbow in the context of your complete medical history. The doctor may press directly on the affected area and ask you to move your elbow, wrist and fingers to see if it causes pain. X-rays are usually not necessary, unless there may be other causes of your elbow pain, such as a fracture or arthritis. Occasionally, magnetic resonance imaging (MRI) scans may be used to show changes in the tendon at the site of attachment onto the bone.
5. Seek Out Treatment
You should stop any activities causing symptoms, apply ice to the area, rest and take pain relievers. You may also need to change your tennis technique or job tasks to reduce stress on your injured tissue. This may mean using two-handed backhands in tennis, keeping your wrist rigid (to place the stress more on the larger arm muscles) during tennis or weight training, and taking ergonomic steps at work.
Counterforce braces and wrist splints may be worn to rest the muscles and tendons. Physical therapy, involving wrist stretching and range of motion exercises, may help to gradually strengthen the affected muscles and tendons. If symptoms do not improve, corticosteroid injections can be given. This is a bit controversial, because surgical specimens of resected tissue do not show much active inflammation, and corticosteroids are used to treat inflammation. Overall, injections seem to have the most short-term benefit, whereas physical therapy has better long-term results. Extracorporeal shock wave therapy (ESWT), low-level laser therapy (LLT) and iontophoresis have not, as of yet, been conclusively shown to have any benefit.
Surgery is used in the 10 percent of the cases in which patients do not improve with the other methods. The outpatient surgical procedure involves removing diseased tendon tissue via a small incision or through an arthroscope.
