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

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.

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 needed.

Tennis elbow symptoms may include:

• Pain that radiates from the outside of your elbow into your forearm and wrist
• Pain when you extend your wrist
• Forearm weakness
• Pain that gets worse over weeks or months
• A painful grip during certain activities, such as shaking hands or turning a doorknob
• An inability to hold certain objects, such as a coffee cup

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

When to see a doctor
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

Click to Enlarge

Tennis elbow

Tennis elbow is an overuse injury. The cause is 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, including using plumbing tools, painting, raking and weaving, can cause tennis elbow.

Tennis elbow is most common in adults ages 30 to 50 — but the condition can affect anyone who repetitively stresses the wrists.

Anyone who uses repetitive movements for at least two hours a day is at greater risk. People who smoke also have a higher risk of developing tennis elbow.

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.

You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred to an orthopedic surgeon or a sports medicine specialist.

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your appointment. For tennis elbow, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What treatments are available, and which do you recommend for me?
• Are there any exercise restrictions that I need to follow?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

What to expect from your doctor
Your doctor is likely to ask you a number of questions as well, such as:

• Where is your pain located?
• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime
While you're waiting to see your doctor, stop doing the exercise or activity that worsens your symptoms, if possible. Ice the area several times a day for about 15 minutes at a time. Wrapping the area with an elastic wrap or bandage also may help keep the swelling down.

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 ultrasound or magnetic resonance imaging (MRI) scans — are done.

If the pain isn't interfering with your ability to function, you can take a wait-and-see approach to tennis elbow treatment. Tennis elbow often gets better on its own in six months to two years.

If you're in too much pain or if the pain is affecting your function, 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.
• Orthotics. 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 treatments called phonophoresis or iontophoresis.
• 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 you have persistent pain and you've tried other treatments for longer than six months. 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 buffered platelet-rich plasma injections, acupuncture, botulinum toxin and topical nitric oxide.

Follow the instructions for P.R.I.C.E. — protection, rest, ice, compression, elevation:

• Protection. Protect your elbow from further injury by not using the joint. If a particular sport or work activity causes symptoms, you may have to stop the activity until your symptoms improve.
• Rest. Give your elbow a rest. But don't avoid all activity. Sometimes, wearing a forearm splint at night helps reduce morning symptoms.
• Ice. Use a cold pack, ice massage, slush bath or compression sleeve filled with cold water to limit swelling after an injury. Try to apply ice as soon as possible after the injury.
• Compression. Use an elastic wrap or bandage to compress the injured area.
• Elevation. Keep your elbow above heart level when possible to help prevent or limit swelling.

These steps may help you prevent a tennis elbow injury:

• Review your technique. Have a tennis professional review your technique to see if you're using the proper motion. Swing the racket with your whole arm and get your entire body involved in the stroke, not just your wrist. Keep your wrist rigid during ball contact. Also, make sure you have the proper racket grip size and string tension. A lower string tension transmits less force up to the elbow.
• Build your strength. Prepare for any sport season with appropriate preseason conditioning. Do strengthening exercises with a hand weight by flexing and extending your wrists. Letting the weight down slowly after extending your wrist is one way of building strength so that force is absorbed into your tissue.
• Keep your wrist straight. During any lifting activity — including weight training — or during tennis strokes, try to keep your wrist straight and rigid. Let the bigger, more powerful muscles of your upper arm do more of the work than your smaller forearm muscles do.
• Warm up properly. Gently stretch the forearm muscles at your wrist before and after use.
• Use ice. After heavy use of your arm, apply an ice pack or use ice massage. For ice massage, fill a sturdy paper or plastic foam cup with water and freeze it. Then, roll the ice directly on the outside of your elbow in a circular motion for five to seven minutes.