Tennis elbow (Lateral Epicondylitis) 

Written by Doctor Athena Au

Last updated: 2022 November 10^th

Q: Doctor, I’ve never played tennis; why do I have tennis elbow?

Tennis elbow is a painful condition on the outside of your elbow.  The correct clinical name is Lateral Epicondylitis.  It is caused by repeat overload of the forearm extensor muscles and tendons, leading to muscle micro-tears, inflammation, and pain.  It is being given the name ‘tennis elbow’ since it is common amongst tennis players and athletes who play racquet sports.  However, other sports or activities can also cause this condition.  For example, individuals with regular heavy lifting, fencers and musicians can also suffer from tennis elbow.

Tennis Elbow Symptoms 

Since Tennis Elbow mostly results from overuse of the arm, the symptoms usually won't pop out immediately.  You will experience pain gradually over the months.  Other signs that indicate you might have a tennis elbow include:

• Burning Sensation and pain occur at the outer side of your elbow while trying to lift or bend your arm. The pain can radiate towards your wrist and can get more serious during the night
• Stiffness or Pain when stretching your arm

• Grip weakening:  You will notice this when you try to hold a racket or pencil or shake someone's hand

• Pain when twisting your arm. ( actions such as turning a doorknob or opening a bottle)

How to diagnose a Tennis Elbow? 

Diagnosis of tennis elbow is usually by physical examination.  Your practitioner will examine your elbow joint to find if pain, swelling and stiffness exist.  Further, check with you about your daily activities that might cause the pain.  Under certain circumstances, cross-examination might be needed to confirm the initial diagnosis:

1. X-ray: Your practitioner might order an X-ray to rule out other look-alike problems such as arthritis or fracture.
2. Other imaging tests, such as ultrasound, MRI or CT, to assess the damage on the tendon and muscle
3. EMG to check if the nerves are being compressed 

Treatment of Tennis Elbow 

Early treatment of this condition is paramount to stop it from becoming a long-term problem.  Treatment for tennis elbow is multimodal.  The first line of treatment is usually conservative:

• REST: avoid doing activities that would strain the affected muscles and tendons. Suppose your work contributes to this problem; alternate the work activities to rest your muscles.
• Painkillers/anti-inflammatory drugs (NSAIDS): It's okay to take this medication to help to ease the pain and inflammation.
• Physiotherapy: The therapist will use a variety of methods to help you to restore your movement and help to reduce the pain. They may use manual therapy such as massage and manipulation to relieve the pain and stiffness. They also will show you how to exercise to keep your arm mobile and strengthen the forearm muscle. They will also apply braces/strapping/Splint to help you limit your forearm and allow them to rest.
• Steroid injection: Usually, this is applied when other treatment fails. Steroids decrease inflammation in the affected muscle and tendon. This should be combined with other treatment modalities, such as NSAIDs and physiotherapy, to maximize the effect.
• Shockwave Therapy: Shockwave is a non-invasive treatment with high energy shockwave that lands on the injured tissue; the shockwave will break up the scar tissues, and blood flow to the damaged area improves. The effect of shockwave on tennis elbow has been reported positive in some cases.
• PRP injection: PRP (Platelet-rich plasma) is a blood plasma containing concentrated platelets from your body that helps repair damaged tissue. PRP injections have been shown to speed up the healing process in some people. However, long-term effects are yet to know.
• Surgery: Suppose the above treatments fail, and you are showing severe and persistent pain. In that case, your doctor might recommend surgery to remove the bundles of inflamed muscles and surrounding scars. The procedure is a day procedure under local anaesthesia.

What is a Tennis Elbow Brace?

A tennis elbow brace helps treat this condition in 2 ways. First, the band limits muscle expansion and the force exerted across the affected muscle, the Extensor Carpi Radialis Brevis (ECRB), hence letting the muscle rest and heal.  

The compressive effect also helps with reducing pain. Secondly, the band serves as a reminder to patients to rest and avoid exacerbating motions.

If you think you may suffer from this condition, find your nearest upper limb specialist for a proper assessment to start treatment early.