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Tennis Elbow

Definition :
Tennis elbow (lateral epicondylitis) is one of several overuse injuries that can affect your elbow. As you might guess, playing tennis is one cause of tennis elbow — but many other common activities can cause tennis elbow, too.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to the bony prominence on the outside of your elbow (lateral epicondyle). Pain can also spread into your forearm and wrist.

Tennis elbow is similar to golfer's elbow. But golfer's elbow occurs on the inside — rather than on the outside — of your elbow.

The pain of tennis elbow doesn't have to keep you from enjoying your favorite activities. Rest and over-the-counter pain relievers often help. Rarely, surgery is an option.

Causes :
Tennis elbow is an overuse injury. It's caused by repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in inflammation or a series of tiny tears in the tendons that attach the forearm muscles to the bone at the outside of your elbow.
As the name tennis elbow indicates, playing tennis — particularly, repeated use of the backhand stroke with poor technique — is one possible cause of the condition. However, many other common arm motions can cause tennis elbow, too — including using a screwdriver, hammering, painting, raking, weaving and others.

Risk Factor :
Tennis elbow is most common in adults ages 30 to 60 — but the condition can affect anyone who repetitively stresses the wrists. Tennis players, carpenters, gardeners, dentists and musicians may be at particular risk.

When to seek medical advice :
Talk to your doctor if self-care steps such as rest, ice and use of over-the-counter pain relievers don't ease your elbow pain and tenderness. Seek immediate care if :

  • Your elbow is hot and inflamed, and you have a fever
  • You can't bend your elbow
  • Your elbow looks deformed
  • You suspect you've broken a bone
Symptoms :
Signs and symptoms of tennis elbow may include :
  • Pain that radiates from the outside of your elbow into your forearm and wrist
  • Pain when you touch or bump the outside of your elbow
  • Pain when you extend your wrist
  • A weak grip
  • A painful grip during certain activities, such as shaking hands or turning a doorknob

The pain often gets worse over weeks or months. Sometimes you may feel pain even when your arm is still.

Dignosis :
Your doctor may be able to diagnose tennis elbow by examining your elbow and based on your medical history. To evaluate pain and stiffness, your doctor may apply pressure to the affected area or ask you to move your elbow, wrist and fingers in various ways.

An X-ray can help your doctor rule out other possible causes of elbow pain, such as a fracture or arthritis. Rarely, more comprehensive imaging studies — such as magnetic resonance imaging (MRI) scans — are done.

Complications :
Left untreated, tennis elbow can result in chronic pain — especially when lifting or gripping objects. Using your arm too strenuously before your elbow has healed can make the problem worse.

Initial treatment of tennis elbow usually involves self-care steps including rest, icing the area and use of acetaminophen (Tylenol, others) or over-the-counter anti-inflammatory medications, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others). These medications aren't recommended for long-term use because they can cause serious gastrointestinal problems.

If those steps don't help and you still have pain and limited motion, your doctor may suggest other steps. These may include :

  • Analyzing the way you use your arm. Your doctor may suggest that experts evaluate your tennis technique or job tasks to determine the best steps to reduce stress on your injured tissue. This may mean going to a two-handed backhand in tennis or taking ergonomic steps at work to ensure that your wrist and forearm movements don't continue to contribute to your symptoms. By keeping your wrist rigid during tennis strokes, lifting or weight training, you use the larger muscles in the upper arm, which are better able to handle loading stress.
  • Exercises. Your doctor or a physical therapist may suggest exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm. Once you've learned these exercises, you can do them at home or at work. Your doctor may also suggest you wear straps or braces to reduce stress on the injured tissue.
  • Corticosteroids. If your pain is severe and persistent, your doctor may suggest an injection of a corticosteroid medication. Corticosteroids are drugs that help to reduce pain, swelling and inflammation. Injectable corticosteroids rarely cause serious side effects. However, these medications don't provide a clear long-term benefit over physical therapy exercises or taking a wait-and-see approach and simply resting your arm. Your doctor may also suggest use of topical corticosteroids for pain relief. These corticosteroids are absorbed through your skin during a treatment called phonophoresis.
  • Surgery. If other approaches haven't relieved your pain and you've been faithful to your rehabilitation program, your doctor may suggest surgery. Your doctor will generally recommend surgery only if your arm movement is still restricted and you've tried other treatments for about a year. Only about one in 10 people with tennis elbow needs surgery.

    You'll be able to have the surgery done on an outpatient basis, meaning you can go home the same day. Surgery involves either trimming the inflamed tendon, or surgically releasing and then reattaching the tendon to relieve pain.

Other treatments for tennis elbow are under investigation. Some treatments being studied include low-energy shock wave treatment, acupuncture, botulinum toxin, orthotic devices, such as braces or straps, and treatment with topical nitric oxide.

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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