Lateral epicondylitis is pain over the bone on the outside of the elbow. The piece of bone that can be felt on the outside of the elbow is called the lateral epicondyle. When the tendons attached to this bone are overused, they can deteriorate and become painful. This is called tendinopathy .
Lateral epicondylitis is commonly called tennis elbow, but it is not restricted to people who play tennis. It occurs in people who do manual labor with their hands, such as roofers and carpenters.
Tennis elbow is caused by overusing the forearm extensor muscles. These muscles extend the wrist and are active when you grip something, such as a tennis racquet. Overusing these muscles can cause deterioration or tearing of the tendons attached to the lateral epicondyle.
Causes include:
A risk factor is something that increases your chance of getting a disease, condition, or injury. Risk factors include:
Symptoms include:
The doctor will ask about your symptoms and medical history, your recent physical activity, and how the injury occurred. You may not remember the event that caused the injury because tennis elbow pain develops over time. The doctor will examine your elbow for:
X-rays are not usually necessary. However, the doctor may x-ray your elbow to make sure the bones of the elbow are normal, and that there is no calcium deposit in the tendon attachments.
Treatment includes:
Do not do activities that cause pain. Do not play sports, especially tennis, until the pain is gone.
Apply ice or a cold pack to the outside of the elbow for 15-20 minutes, four times a day for several days. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
Take one of the following drugs to help reduce inflammation and pain:
If you still have tenderness in the elbow while taking these drugs, do not return to physical activity. Check with your doctor.
Wear a counter-force brace on your forearm if recommended by your doctor. This brace limits the force generated by your forearm muscles when you use them.
Apply heat to the elbow only when you are returning to physical activity. Heat is helpful before stretching or when you are getting ready to play sports.
When the acute pain is gone, start gentle stretching of the wrist and elbow as recommended by a healthcare professional. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times.
Begin strengthening exercises for your wrist extensor muscles as recommended.
Begin arm motions of your sport or activity, such as tennis strokes, as recommended.
The doctor may inject cortisone into the tendon attachment at the lateral epicondyle. This may help to reduce pain and inflammation.
According to a recent study involving 198 adults suffering from tennis elbow, eight sessions of physical therapy combining elbow manipulation with prescribed exercises improved symptoms in the short-term more than a wait-and-see approach. In the same study, corticosteroid injections were helpful in the first six weeks, but no better than physical therapy after the first six weeks and associated with recurrences later on. After one year, none of the three approaches were superior. *
To reduce your risk of getting tennis elbow:
RESOURCES:
American Academy of Orthopaedic Surgeons
http://www.aaos.org
American Orthopaedic Society for Sports Medicine
http://www.aossm.org/
CANADIAN RESOURCES:
Alberta Health and Wellness
http://www.health.gov.ab.ca/
Capital Health
http://www.cdha.nshealth.ca/index.cfm
References:
American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org .
The American Orthopaedic Society for Sports Medicine website. Available at: http://www.sportsmed.org .
Human Tendons. Human Kinetics; 1997.
Keeping tennis elbow at arm's length. Phys Sportsmed. May 1996.
Nicholas Institute of Sports Medicine and Athletic Trauma website. Available at: http://www.nismat.org/ .
Nirschl RP, Kraushaur BS. Assessment and treatment guidelines for elbow injuries. Phys Sportsmed. 1996;24.
Updated section on Treatment on 11/8/06 according to the following study, as cited by DynaMed's Systematic Literature Surveillance : Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333:939.
Last reviewed November 2008 by John C. Keel, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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