Tennis elbow is clinically named lateral epicondylitis, and it is not only a cause of pain in tennis players. It is also common in people who do not practice sports but for some reason make heavy use of their forearm muscles. Most people with tennis elbow pain has never played tennis before.
It happens in carpenters, painters, cooks, heavy computer users, and many others, and it is more common after the age of 40 years old.
This condition is mostly caused by overuse and damage to the muscles in the forearm. In time, the tendon of the forearm muscles gets inflamed and start causing pain.
That is why pain from lateral epicondylitis appears gradually over a long period of time (weeks or months), and becomes worse as we continue performing the same repetitive movements.
Symptoms of Tennis Elbow (lateral epicondylitis)
The pain associated with tennis elbow can be quite self-limiting and troublesome, especially in advanced stages of the disease. There’s a gradual onset, but since patients do not have any specific trauma, they usually think it is the result of older age and do not pay much attention to the symptoms until they become severe.
The most severe pain usually starts one or two days after performing repetitive activities with the wrist, such as weight lifting, an improper stroke technique in tennis, lifting grocery bags, typing, and many other movements that require extending your wrists.
The pain is often perceived in the lateral elbow and sometimes radiates to the posterior area in your forearm. You might notice it gets worse if you perform wrist movements, and it gets better if you stop using your articulation.
Both mild and severe tennis elbow pain can cause problems. Mild pain would make it difficult to keep practising sports or using hand tools that require continuous wrist movements. In severe cases, patients report an unbearable pain after using the affected hand, for example, to pick up and hold a cup of coffee. Gripping becomes a real challenge, and sometimes patients would even have difficulty holding a fork or a knife for a long time.
Everyday tasks become such as opening a jar or turning a doorknob become difficult, and this contributes to a growing feeling of distress and frustration in most patients. Some would even try to exercise the wrist and elbow articulation to make it better, but they don’t know doing that will only make it worse.
Patients with a severe condition usually have muscle weakness in most parts of the upper extremity, especially the hands, the wrist and the forearms. In some cases, they would suddenly experience stiffness when trying to move their elbow, and that is why they wonder where does the pain really come from? Why does it affect both the hands and the elbows? Moreover, is there anything we can do about it?
Where does the pain come from and what can be done?
The maximum pain usually comes from the area of the forearm where the muscles are attached to the bone. The affected forearm muscles are extensor muscles that move the wrists towards your body in a 90° position. In most cases, the cause of the pain is located in an extensor muscle called Extensor Carpi Radialis Brevis, usually known as ECRB. This muscle stabilises the wrist during heavy activity, and when it gets weakened from overuse, the tendon starts to undergo microscopic tears that become inflamed and trigger pain.
Thus, the origin of the pain is located near the elbow, but since the muscle activity extends to the wrist and the hands, you will have muscle weakness and pain symptoms in the elbows and down to your hands. This is why you will notice your doctor examining not only your elbow but your entire upper extremities to figure out the cause of the pain and to confirm the diagnosis of tennis elbow.
The best thing you can do if you are experiencing tennis elbow pain is resting, icing, protecting the articulation, and reduce swelling by taking nonsteroidal anti-inflammatories (AINEs).
- Resting: As we mentioned earlier, it is a mistake trying to lubricate your joint by moving it around or exercising your elbow. This can be done to reduce stiffness, but you need to ask your doctor if you want to do it appropriately. Otherwise, it will not relieve the pain but make it worse because every repetitive movement will only result in more microscopic tears and more inflammation. What you need to do is to rest your articulation. This will allow the tissue to heal properly and your symptoms will improve gradually.
- Icing: It is well known that ice is a good remedy against inflammation, and this is one of the main causes of tennis elbow. While it is true that icing will not speed up the healing process, it will definitely reduce the severity of the pain and the inflammation in the affected tendon. You can apply ice every 4 hours for some minutes, and your condition will take 2 or 3 days to improve. Avoid applying ice directly to your elbows and opt for cold compresses or covering ice with a blanket or fabric.
- Protecting: Remember that tennis elbow results from microscopic injuries in the tendon of extensor muscles in your forearm. Thus, it would be a good idea to use an elbow strap and protect your articulation from further damage.
- AINEs: In most cases, over-the-counter drugs are enough to improve the symptoms along with resting, icing, and protecting the articulation. However, if your pain does not improve, your doctor might also recommend stronger painkiller or steroid injections.
|Population that plays tennis regularly in the UK||2 million people|
|Percentage of tennis players with tennis elbow||10-50%|
|Diagnosed tennis elbows in non-players||95%|
|High risk population by age||40-60 years|
|Estimated recovery time||6-12 weeks|
Table 1. Interesting facts about Tennis Elbow
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Lai, W. C., Erickson, B. J., Mlynarek, R. A., & Wang, D. (2018). Chronic lateral epicondylitis: challenges and solutions. Open access journal of sports medicine, 9, 243.
Lee, S., Ko, Y., & Lee, W. (2014). Changes in pain, dysfunction, and grip strength of patients with acute lateral epicondylitis caused by frequency of physical therapy: a randomized controlled trial. Journal of physical therapy science, 26(7), 1037-1040.
Tosti, R., Jennings, J., & Sewards, J. M. (2013). Lateral epicondylitis of the elbow. The American journal of medicine, 126(4), 357-e1.