Tennis Elbow by Kathleen D. Wright
Author/s: Kathleen D. Wright
Tennis elbow is an inflammation of several
structures of the elbow. These include muscles,
tendons, bursa, periosteum, and epicondyle (bony
projections on the outside and inside of the elbow,
where muscles of the forearm attach to the bone of
the upper arm). This condition is also called
epicondylitis, lateral epicondylitis, medial
epicondylitis, or golfer's elbow, where pain is
present at the inside epicondyle.
The classic tennis elbow is caused by repeated
forceful contractions of wrist muscles located on
the outer forearm. The stress, created at a common
muscle origin, causes microscopic tears leading to
inflammation. This is a relatively small surface
area located at the outer portion of the elbow (the
lateral epicondyle). Medial tennis elbow, or medial
epicondylitis, is caused by forceful, repetitive
contractions from muscles located on the inside of
the forearm. All of the forearm muscles are involved
in tennis serves, when combined motions of the elbow
and wrist are employed. This overuse injury is
common between ages 20-40.
People at risk for tennis elbow are those in
occupations that require strenuous or repetitive
forearm movement. Such jobs include mechanics or
carpentry. Sport activities that require individuals
to twist the hand, wrist, and forearm, such as
tennis, throwing a ball, bowling, golfing, and
skiing, can cause tennis elbow. Individuals in poor
physical condition, who are exposed to repetitive
wrist and forearm movements for long periods of
time, may also be prone to tennis elbow.
Causes & symptoms
Tennis elbow pain originates from a partial tear of
the tendon and the attached covering of the bone. It
is caused by chronic stress on tissues attaching
forearm muscles to the elbow area. Individuals
experiencing tennis elbow may complain of pain and
tenderness over either of the two epicondyles. This
pain increases with gripping or rotation of the
wrist and forearm. If the condition becomes
long-standing and chronic, a decrease in grip
strength can develop.
Diagnosis of tennis elbow includes the individual
observation and recall of symptoms, a thorough
medical history, and physical examination by a
physician. Diagnostic testing is usually not
necessary unless there may be evidence of nerve
involvement from underlying causes. X rays are
usually always negative because the condition is
primarily soft tissue in nature, in contrast to a
disorder of the bones.
Heat or ice is helpful in relieving tennis elbow
pain. Once acute symptoms have subsided, heat
treatments are used to increase blood circulation
and promote healing. The physician may recommend
physical therapy to apply diathermy or ultrasound to
the inflamed site. These are two common modalities
used to increase the thermal temperature of the
tissues in order to address both pain and
inflammation. Occasionally, a tennis elbow splint
may be useful to help decrease stress on the elbow
throughout daily activities. Routine exercises
become very important to improve flexibility to all
forearm muscles, and will aid in decreasing muscle
and tendon tightness that has been creating
excessive pull at the common attachment of the
Massage therapy also has been found to be beneficial
if symptoms are mild. Massage techniques are based
primarily on increasing circulation to promote
efficient reduction of inflammation. Manipulation,
acupuncture, and acupressure have been used as well.
Contrast hydrotherapy (alternating hot and cold
water or compresses, three minutes hot, 30 seconds
cold, repeated three times, always ending with cold)
applied to the elbow can help bring nutrient-rich
blood to the joint and carry away waste products.
Botanical medicine and homeopathy may also be
effective therapies for tennis elbow. For example,
cayenne (Capsicum frutescens) ointment or arnica,
wintergreen, or rue oil applied topically may help
to increase blood flow to the affected area and
The physician may also prescribe nonsteroidal
anti-inflammatory drugs (NSAIDS) to reduce
inflammation and pain. Injections of cortisone or
anesthetics are often used if physical therapy is
ineffective. Cortisone reduces inflammation, and
anesthetics temporarily relieve pain. Physicians are
cautious regarding excessive number of injections as
this has recently been found to weaken the tendon's
If conservative methods of treatment fail, surgical
release of the tendon at the epicondyle may be a
necessary form of treatment. However, surgical
intervention is relatively rare.
Tennis elbow is usually curable; however, if
symptoms become chronic, it is not uncommon for
treatment to continue for three to six months.
Until symptoms of pain and inflammation subside,
activities requiring repetitive wrist and forearm
motion should be avoided. Once pain decreases to the
point that return to activity can begin, the playing
of sports, such as tennis, for long periods should
not occur until excellent condition returns. Many
times, choosing a different size or type of tennis
racquet or tool may help. Frequent rest periods are
important despite what the wrist and forearm
activity may be. Compliance to a stretching and
strengthening program is very important in helping
prevent recurring symptoms and exacerbation.
A projection on the surface of a bone; often an area
for muscle and tendon attachment.
A painful and sometimes disabling inflammation of
the muscle and surrounding tissues of the elbow
caused by repeated stress and strain on the forearm
near the lateral epicondyle of the humerous (arm
A fibrous vascular membrane that covers bones.
For Your Information
Hertling, Darlene, and Randolph M. Kessler.
Management of Common Musculoskeletal Disorders:
Physical Therapy Principles and Methods. 2d ed.
Philadelphia: J.B. Lippincott Company, 1990.
Norkin, Cynthia C., and Pamela K. Levangie. Joint
Structure and Function: A Comprehensive Analysis.
Philadelphia: F.A. Davis Company, 1992.
American College of Sports Medicine. PO Box 1440,
Indianapolis, IN 46206-1440 or 401 W. Michigan St.,
Indianapolis, IN 46202. (317) 637-9200. Fax: (317)