Understanding tennis elbow and the treatments available to you.
Tennis elbow, or lateral epicondylitis, is a common injury associated with elbow pain.
Several sports and activities can cause this condition, including playing tennis and other racquet sports.
Tennis elbow is an inflammation of the tendons that connect the forearm muscles on the outside of the elbow. When the same motion is repeated over and over, the muscles and tendons in the forearms become damaged. This is what creates the pain and tenderness on the outside of the elbow..
Your elbow joint is made up of three bones: the humerus, radius, and ulna. The humerus is your upper arm bone and the radius and ulna are in your forearm. At the bottom of the humerus, there are bony bumps called epicondyles. The bump on the outside of your elbow is called the lateral epicondyle.
Your forearm muscles extend your wrist and fingers. Your forearm tends, known as extensors, attach the muscles to the bone. The muscles and bone attach on the lateral epicondyle. The tendon typically injured in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).
Symptoms of tennis elbow gradually develop over time. In most cases, the pain typically starts out mild and eventually worsens as weeks and months pass. There is usually no specific injury involved to cause symptoms.
Common signs of tennis elbow:
Pain or burning on the outer part of the elbow
Pain when lifting objects
Pain radiating down the forearm
The symptoms often worsen with increased forearm activity and are most often found in your dominant arm. Common triggering activities include turning a wrench, holding a racquet, or shaking hands.
Overuse – Tennis elbow is often caused by damage to the ECRB. The ECRB muscle helps stabilize the wrist when the elbow is straight. When the muscle is weakened from overuse this causes microscopic tears to form in the tendon where it attaches to the lateral epicondyle. This creates inflammation and pain. Another risk for damage is the position of the ECRB. When the elbow bends and straightens, the muscle rubs and can eventually create wear and tear of the muscle.
Activities – Although tennis elbow is common in athletes, they are not the only people to develop this condition. There are many other activities that result in repteitive use of the forearm muscle. Carpenters, painters, plumbers, auto workers, and chefs are all known to develop tennis elbow.
Age – The most common age that tennis elbow is developed is between ages 30 and 50.
When you visit a doctor there are many factors that will be considered during diagnosis. These include how your symptoms developed, occupational risk factors, and if you are actively involved in a recreational sport.
You will discuss what activities cause tennis elbow symptoms and the areas on your arm where symptoms occur. If you have previously injured your elbow or have a history of rheumatoid arthritis or nerve disease, be sure to let your doctor know.
Most physical examinations include a variety of tests to pinpoint the diagnosis. Your doctor may ask you to attempt to straighten your wrist and fingers against resistance to check for pain.
Additional testing may be necessary to rule out other possible causes. This may include:
- X-rays: These are used to provide clear images of the bone. An x-ray could be used to rule out arthritis in the elbow.
- MRI scan: If there’s a chance your symptoms may be related to a neck problem, an MRI scan may be ordered. This will provide details on your soft tissues. This will help your doctor see if you have a herniated disk or arthritis in your neck, both of which can cause arm pain.
- EMG: An EMG may be used to eliminate nerve compression. There are numerous nerves surrounding your elbow and the symptoms of nerve compressions align with those of tennis elbow.
Most patients have success with nonsurgical treatment. After diagnosis, it is important to give your arm a break and allow time to rest. This means that all participation in sports or heavy work activities will need to be avoided for a few weeks. In this case, drugs like aspirin or ibuprofen can be used to reduce the pain and swelling.
- Physical therapy: There are specific exercises that are used to strengthen the muscles on your forearm. Your physical therapist may also perform an ice massage or use muscle-stimulating techniques to heal your muscle.
- Brace: Using a brace over the back of your forearm may be recommended to relieve symptoms. This allows the muscles and tendons to rest.
- Steroid injections: Steriods can be injected in the painful area to relieve pain and swelling.
- Check your equipment: If a racquet sport played a role in your tennis elbow, your doctor may want to get your equipment checked. If your racquet is not a proper fit this can cause stress on your forearm.
If your tennis elbow symptoms do not change after 6 to 12 months on nonsurgical treatment, your doctor may recommend surgery. The right surgical approach will vary per patient.
Meet The Specialists
Michael T. Ellerbusch, M.D.
Dr. Ellerbusch received his bachelor’s degree in Biology Pre-Medicine and Chemistry from Murray State University in Murray, Kentucky. While there, he was named a USA Today Academic All-American. He also received the Outstanding Senior Man Award and served as the commencement speaker at the graduation ceremony. He attended medical school at Southern Illinois University School of Medicine in Springfield, Illinois, where he graduated with high honors.
After graduation, he moved to Birmingham, Alabama where he performed one year of residency in Internal Medicine and then completed an additional three years in Physical Medicine and Rehabilitation at the University of Alabama at Birmingham. He served as the Chief Resident during his final year at UAB. He then completed a subspecialty fellowship in Sports Medicine at the Alabama Sports Medicine and Orthopaedic Clinic. After completing his fellowship in 2001, he practiced at the Alabama Orthopaedic and Spine Center of Tuscaloosa. He served as the Medical Director for the Athletic Program at Shelton State Community College as well as serving as Team Physician for multiple high schools in the Tuscaloosa area.
Dr. Ellerbusch joined the practice of Southlake Orthopaedics in 2005. He currently serves as Team Physician for Hoover High School and the associated middle schools. He is currently triple board certified in Physical Medicine and Rehabilitation, Sports Medicine and Electrodiagnostic Medicine. He enjoys seeing a variety of patients for non-surgical treatment, especially in the area of Sports Medicine. He also performs his own electromyograms and nerve conduction studies commonly used in the diagnosis of carpel tunnel syndrome and other nerve entrapments. In addition, he frequently lectures in the areas of non-operative treatment of musculoskeletal injuries, sports medicine, osteoarthritis, nerve conduction studies and electromyography. On a personal level, he enjoys participating in athletics including basketball and golf. He also is active in coaching his son and daughter in various sporting activities in the community. In addition, he is very active at Cahaba Heights Church of Christ where he serves as a deacon.
Ekkehard Bonatz, M.D., Ph.D.
Ekkehard Bonatz, M.D., was born in Wernigerode, Germany. Dr. Bonatz graduated from the Hannover Medical School with a Medical Degree. He completed his orthopaedic surgery residency at the University of Alabama at Birmingham. Dr. Bonatz completed his fellowship in Hand and Microsurgery at UAB. Dr. Bonatz then volunteered for the U.S. Army as an officer in the Medical Corps at Fort Sam Houston, Texas, where he was acting Chief of Hand Surgery. He then joined the faculty at the University of Alabama Department of Surgery in Birmingham in the Hand and Microsurgery Program, eventually becoming an Associate Professor, Division of Orthopaedic Surgery. Subsequently Dr. Bonatz entered private practice at Southlake Orthopaedics Sports Medicine and Spine Center. His practice is geared primarily to elbow, wrist, and hand problems.
Michael D. Smith, M.D.
Dr. Michael Smith is very excited about the opportunity to return to his hometown and practice orthopedic surgery at Southlake Orthopaedics. Both Dr. Smith and his wife love Birmingham & Hoover, and think it is a great privilege to serve in such a dynamic community. Dr. Smith believes in patient-centered care that is thoughtful and focused on the patient’s goals. As a fellowship trained hand surgeon and upper extremity surgeon, he is happy to provide treatments for ailments related to the shoulder, elbow, hand or microvascular problems.