Dr Brian Cable MD explains tennis elbow.

December 1, 2017
Brian Cable MD

What is tennis elbow?

The most common cause of elbow pain is due to the overload of a group of tendons as they attach onto a part the bone known as the lateral epicondyle (Fig 1).  This overload leads to microtears and degeneration of the tendon, a condition known as lateral epicondylitis or ‘tennis elbow’ (Fig 2).

Why do we get tennis elbow?

Muscles and/or tendons overloading and micro-tearing is not unique to the elbow; this process can occur in many areas of the body. In most cases, however, our bodies can readily repair the damage because there is an adequate blood supply to the region (blood brings all the reparative cells and nutrients needed to repair tissue).  The lateral elbow is one of several areas in our bodies where the blood supply is tenuous.  So if we overuse our tendons here, it often fails to heal properly.

Who gets tennis elbow?

The affected tendons at the lateral elbow are responsible for extending the wrist, so any activities which involve repetitive wrist motion can bring on symptoms.  Yes, it frequently occurs in tennis players (particularly with ones who have a poor backhand technique).  However, most people who get tennis elbow don’t play tennis!  More commonly, it is work related, with those of us involved in repetitive gripping or lifting activities who get it.  What or how much you lift isn’t as important as the repetition that causes the condition.

How is tennis elbow diagnosed?

The diagnosis of tennis elbow can almost always be made based on the patient’s symptoms, along with a careful physical exam.  Rarely an imaging study is necessary, however, an ultrasound can be useful if properly performed.

How is tennis elbow treated?

The good news is that the vast majority (>95%) of tennis elbow cases are successfully treated non-operatively.   Treatment options include physical therapy, counterforce bracing (Fig 3), injections, and common sense (stop doing so much of whatever is causing your symptoms).   Cortisone should only be used sparingly because multiple injections can weaken the tendon further.  A promising treatment is platelet-rich-plasma (PRP) injections, which (in theory) may stimulate the healing response (Fig 4).

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Orthopaedic Knowledge Update (OKU) 11, Published by the American Board of Orthopaedic Surgeons, 2014, pg 373-386

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