Elbow pain is a common complaint among athletes and people of all ages. That’s because a large number of conditions can cause elbow pain. Tennis elbow is one of the most common of these, but how do you know that’s what you have?
The proper name of tennis elbow is lateral epicondylitis. “Lateral” in this case means on the outside of the elbow, which is where you’ll feel the pain if you have tennis elbow. On the outside of the elbow is a bony bump known as the lateral epicondyle. Sometimes—for a number of reasons—tendons that connect forearm muscles to the radius, a bone of the lower arm—can get caught on or rub against this bony bump, which causes pain and damage to the tendon.
Causes of Tennis Elbow
Tennis is one of cause of tennis elbow, but it’s not the only one. In fact, more than half of people who have tennis elbow are not tennis players. Anyone who makes certain repetitive movements with their arms—a plumber or carpenter turning a wrench or screwdriver, a painter applying paint to a wall, a chef chopping ingredients, an office worker using a mouse all day—can develop tennis elbow.
Sports and other activities can also cause tennis elbow. Obviously, tennis and other racquet sports like squash are one such category. The backhand stroke and poor serving technique are top contributors to tennis elbow. Other sports that carry a risk of tennis elbow include weight lifting as well as throwing sports, such as baseball, softball and football.
You are also more likely to develop tennis elbow if you are over the age of 30. The majority of people who have tennis elbow are between the ages of 30 and 50.
Diagnosing Tennis Elbow
Physicians will go through a differential diagnosis to determine the cause of a patient’s elbow pain. Elbow pain is a generalized symptom that could apply to or be caused by a number of conditions, so healthcare providers go step-by-step through likely causes, ruling them out one by one.
Pain on the outside of the elbow is the main symptom of tennis elbow. Pain in other areas on or near the elbow is usually a different condition.
For example, if you feel pain—or felt a pop—on the top of your elbow, close to the end of the biceps muscle, that’s more likely to be biceps tendinitis or a biceps tendon rupture. Similarly, if the pain is more on the underside of the elbow by the triceps muscle, that could be bursitis—inflammation of the fluid-filled sac that lubricates the elbow joint.
Pain on the inside of the elbow could be tennis elbow’s counterpart medial epicondylitis, also known as golfer’s elbow. This pain comes from the forearm flexor tendons on the inside of the elbow.
Damage to the ulnar collateral ligament (UCL) could be another culprit of pain on the inside of the elbow. The UCL connects the upper arm bone (humerus) to the ulna, one of the bones of the forearm. This injury often requires a UCL reconstruction, better known as Tommy John surgery.
Tennis Elbow Treatment
Most cases of tennis elbow do not need surgery. When patients first notice elbow pain, I always recommend the RICE protocol right away:
- Rest the elbow joint
- Apply ice when you feel pain or after activity
- Wear some sort of compression garment or sleeve
- Elevate the arm above the heart
Following the RICE protocol can help reduce pain, inflammation and swelling of the elbow joint and the tendons involved in lateral epicondylitis. Over-the-counter medications such as ibuprofen or aspirin—members of a class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs)—can also provide relief from symptoms.
Experimental treatments such as stem cell therapy and platelet rich plasma (PRP) can be a bridge between conservative treatments and surgery. Stem cells are specialized cells that can turn into other types of cells. They are harvested from the patient’s own bone marrow, and the hope is that the stem cells will become tendon cells and help heal the tennis elbow. PRP uses isolated compounds from the patient’s blood to speed healing at an injury site.
Surgery for tennis elbow involves removing damaged muscle and tendon tissue—a process known as debridement. In the most severe cases, surgery is necessary to reattach the tendon to a bone.
Surgery, when it is necessary, can be done as an open or as an arthroscopic procedure. An open procedure involves a bigger incision (though still small; my incisions are only about ¾ of an inch) so the surgeon can see the tendons directly. Arthroscopy uses small tools, small incisions and a flexible camera called an arthroscope that is attached to a video monitor.
Arthroscopic surgery usually means a faster recovery and lower rates of complication than an open surgery. However, an arthroscopic procedure is not always the best choice for the patient or the surgeon, and most of the tennis elbow surgeries my colleagues and I perform are open. Open surgery has been the standard for more than 50 years and produces excellent outcomes.
If you are experiencing pain in the elbow, request an appointment with me or one of my colleagues at Summit Medical Group Orthopedics. We will be able to diagnose the cause of your elbow pain and suggest treatment options.