Lateral epicondylitis, also known as ‘Tennis Elbow‘ is a common ailment amongst far more than just tennis players. The causes of tennis elbow are many and varied, with tennis actually being on of the lesser common.
What structures make up the elbow joint?
The elbow is made up of three bones, which are connected by muscles, ligaments and tendons. The humerus is the large upper arm bone. The ulna and radius are the two bones in the forearm. Looking at the forearm with the palm of the fingers facing up, the ulna is located on the inner (medial) aspect of the forearm. The radius is located on the outer (lateral) aspect of the forearm. Projecting from the end of the humerus are the medial and lateral epicondyles. The epicondyles are the boney attachment sites for many of the forearm muscles.
The muscles that move the fingers and the wrist start at the elbow. These muscles attach via tendons to the medial and lateral epicondyles. Again, looking at the forearm with the palm of the fingers facing up, the forearm muscles that start on the medial epicondyle help to flex (move upwards, towards the face) the wrist and fingers. The forearm muscles that start on the lateral epicondyle help to extend (move downwards, away from the face) the wrist and fingers.
(image credit – Rukia13)
What is “Tennis Elbow”?
“Tennis Elbow” (a.k.a. lateral epicondylitis) is the term used to describe irritation (inflammation) of the tendons that connect the muscles that extend the wrist and fingers to the lateral epicondyle of the elbow. A common site for tennis elbow to occur is right at the attachment site of the tendons to the lateral epicondyle. Although this site is the most common, inflammation can occur anywhere along the tendons.
What does tennis elbow feel like?
Tennis elbow usually begins with a gradual onset of dull, intermittent in the outer part of the elbow. It may progress and develop into a sharp continuous pain. Repetitive use of the elbow or arm can increase the pain. Tenderness is often present over the lateral epicondyle of the elbow. Pain can often be experienced during simple activities like picking up a cup of coffee; this is known as the “Coffee Cup Sign.”
What causes tennis elbow?
Tennis elbow usually develops as a result of overuse. Repetitive use of the elbow and arm can cause undue stress on the tendons that extend the wrist and fingers. This in turn leads to the development of microscopic tears in the tendons that extend the wrist and fingers resulting in inflammation and pain. Training errors, weakness of the forearm muscles, poor equipment or inadequate off-season training are some of the other factors that can cause tennis elbow. Finally, tennis elbow can develop as a result of direct trauma or after an elbow injury such as a fracture.
Can tennis elbow be detected on X-rays?
Inflammation of the tendons that extend the wrist and fingers cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in individuals with tennis elbow these x-rays are usually normal. Other diagnostic tests, such as bone scans, blood work or MRI’s, are not usually required in typical cases of tennis elbow.
What is the treatment for tennis elbow?
The treatment of tennis elbow should be individualized. Treatment may include relative rest and icing to decrease pain around the lateral epicondyle, stretching and strengthening exercises, anti-inflammatory medications or a tennis elbow strap. A cortisone injection may be required to reduce inflammation and pain. The above measures are usually successful and surgery is rarely required.