1. What is tennis elbow?
Tennis elbow is the most common cause of pain around the elbow. It frequently occurs in tennis players, but you don’t have to play tennis to get it. The old name for this condition was lateral epicondylitis, because it used to be thought that it was caused by inflammation around the lateral epicondyle. However we now know that the true cause is degeneration (wear and tear) of two of the tendons which attach to the lateral epicondyle. These are the ECRB tendon and the common extensor tendon (see diagram below). These tendons anchor the wrist extensors, the muscles which bend your wrist backwards, and they are mainly active when gripping.
Why does tennis elbow happen?
Tendon wear and tear, or degeneration, is known as tendinopathy, a problem which affects many tendons around the body when we get to middle age and beyond. These degenerate tendons are not as strong as normal healthy tendons, and are more prone to injury, particularly when exposed to repetitive forces. The tennis back-hand places significant stress on the wrist extensor tendons and is the classical cause of tennis elbow. Many middle-aged tennis players suffer to a certain degree. However it can also be caused by other racquet sports, by golf, by using a computer for long periods of time, or even by normal day to day activities. Once the degenerate tendon has been injured, repeated low-level trauma prevents the tendon from healing and creates a vicious circle.
What are the symptoms of tennis elbow?
The main symptom is pain on the outside of the elbow. It is typically felt around the lateral epicondyle which is the main bony prominence on the outer (lateral) side of your elbow. The pain often radiates down the outside of the forearm and is generally worse when gripping forcibly. Straightening your elbow may also be uncomfortable. The pain is generally eased by rest and aggravated by activity.
What happens if it isn’t treated?
It is often a self-limiting condition, and many cases will settle spontaneously by 12 months. However it is important to rest the tendon in order to give it a chance to heal. There are various non-operative treatments, including an elbow clasp, physiotherapy, injections, and shock-wave treatment. Surgery is usually only considered if these measures are unsuccessful. However with modern therapies such as PRP and extracorporeal shock-wave treatment (ESWT), an operation is rarely necessary.