Lateral Epicondylitis -
Tennis Elbow
Lateral Epicondylitis (Tennis Elbow)
Written by Pierre Rouzier, M.D., for RelayHealth
What is lateral epicondylitis (tennis elbow)?
Lateral epicondylitis (tennis elbow) is the name for a condition in which the bony bump at the outer side of the elbow is painful and tender.
The elbow joint is made up of the bone in the upper arm (humerus) and one of the bones in the lower arm (ulna). The bony bumps at the bottom of the humerus are called epicondyles. The bump on the outer side of the elbow, to which certain forearm muscles are attached by tendons, is called the lateral epicondyle.
Lateral epicondylitis is also referred to as wrist extensor tenclonitis.
How does it occur?
Tennis elbow results from overusing the muscles in your forearm that straighten and raise your hand and wrist. When these muscles are overused, the tendons are repeatedly tugged at the point of attachment (the lateral epicondyle). As a result, the tendons become inflamed. Repeated, tiny tears in the tendon tissue cause pain. Among the activities that can cause tennis elbow are tennis and other racket sports, carpentry, machine work, typing, and knitting.
What are the symptoms?
The symptoms of tennis elbow are:
• pain or tenderness on the outer side of the elbow
• pain when you straighten or raise your wrist and hand
• pain made worse by lifting a heavy object
• pain when you make a fist, grip an object, shake hands, or turn door handles
• pain that shoots from the elbow down into the forearm or up into the upperarm.
How is it diagnosed?
Your healthcare provider will ask you about your daily and recreational activities. He or she will examine your elbow and arm and will have you do movements that may cause pain in the outer part of your elbow. You may have X-rays of the elbow.
How is it treated.?
Treatment includes the following:
• Put an ice pack on your elbow for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the pain goes away.
• You can also do ice massage. Massage your elbow with ice by freezing water in a Styrofoam cup. Peel the top of the cup away to expose the ice and hold onto the bottom of the cup while you rub the ice over your elbow for 5 to 10 minutes.
• Wear a tennis elbow strap. This strap wraps around the forearm below the elbow and helps keep the forearm muscles from pulling on the painful epicondyle.
• Take anti-inflammatory pain medicine, such as ibuprofen (Advil). Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider's approval.
• Do the exercises recommended by your healthcare provider. Your provider may also recommend physical therapy.
• Your provider may recommend an injection of a corticosteroid medicine around the lateral epicondyle to reduce the inflammation.
• In severe cases, surgery may be recommended.
You will need to avoid or reduce racket sports or other activities that involve repetitive motion of the elbow (hammering, unscrewing jars, or using a screwdriver) until your symptoms go away. Try to lift objects with your palm facing up to keep from overusing your lateral epicondyle.
How long will the effects last?
The length of recovery depends on many factors such as your age and health, and if you have had a previous injury. Recovery time also depends on the severity of the injury. A mild injury may recover within a few weeks, whereas a severe injury may take 6 weeks or longer to recover. This problem can sometimes be long-lasting and can even come back once you are better. You need to stop doing the activities that cause pain until your elbow has healed. If you continue doing activities that cause pain, your symptoms will return and it will take longer to recover.
When can I return to my normal activities?
Everyone recovers from an injury at a different rate. Return to your activities will be determined by how soon your elbow recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible.
You may return to your sport or activity when you are able to forcefully grip things, like a tennis racket or golf club, or do activities such as working at a keyboard without pain in your elbow. It is important that there is no swelling around your injured elbow and that it has regained its normal strength compared to your uninjured elbow. You must have full range of motion of your elbow.
How can I take care of myself?
To help take care of yourself, follow the full treatment your healthcare provider prescribes. In addition, you can:
• Get enough sleep and avoid becoming overtired.
• Avoid painful activities, including racket sports, shaking hands, hammering, unscrewing jars, or using a screwdriver.
How can I prevent tennis elbow?
To prevent tennis elbow:
• Use proper form during your activities, whether they are sports or jobrelated. For instance, be sure your tennis stroke is correct and that your tennis racket has the proper grip size.
• Warm up before playing tennis or doing other activities that involve your elbow or arm muscles. Gently stretch your elbow and arm muscles before and after exercise.
• Ice your elbow after exercise or work.
• In job-related activities, be sure your posture is correct and that the position of your arms during your work doesn't cause overuse of your elbow or arm muscles.
Rehabilitation Exercises
Wrist active range of motion: Flexion and extension
Wrist stretch
Forearm pronation and supination
Active elbow flexion and extension
Rehabilitation Exercises
You may do the stretching exercises right away. You may do the strengthening exercises when stretching is nearly painless.
Stretching exercises
• Wrist active range of motion: Flexion and extension: Bend your wrist forward and backward as far as you can. Do 3 sets of 10.
• Wrist stretch: With one hand, help to bend the opposite wrist down by pressing the back of your hand and holding it down for 15 to 30 seconds. Next, stretch the hand back by pressing the fingers in a backward direction and holding it for 15 to 30 seconds. Keep your elbow straight during this exercise. Do 3 sets on each hand.
• Forearm pronation and supination: With your elbow bent 900, turn your palm upward and hold for 5 seconds. Slowly turn your palm downward and hold for 5 seconds. Make sure you keep your elbow at your side and bent 900 throughout this exercise. Do 3 sets of 10.
• Active elbow flexion and extension: Gently bring your palm up toward your shoulder and bend your elbow as far as you can. Then straighten your elbow as far as you can 10 times. Do 3 sets of 10.
Strengthening exercises
• Wrist flexion: Hold a can or hammer handle in your hand with your palm facing up. Bend your wrist upward. Slowly lower the weight and return to the starting position. Do 3 sets of 10. Gradually increase the weight of the can or weight you are holding.
• Wrist extension: Hold a soup can or hammer handle in your hand with your palm facing down. Slowly bend your wrist upward. Slowly lower the weight down into the starting position. Do 3 sets of 10. Gradually increase the weight of the object you are holding.
• Wrist radial deviation strengthening: Put your wrist in the sideways position with your thumb up. Hold a can of soup or a hammer handle and gently bend your wrist up, with the thumb reaching toward the ceiling. Slowly lower to the starting position. Do not move your forearm throughout this exercise. Do 3 sets of 10.
• Forearm pronation and supination strengthening: Hold a soup can or hammer handle in your hand and bend your elbow 900. Slowly rotate your hand with your palm upward and then palm down. Do 3 sets of 10.
• Wrist extension (with broom handle): Stand up and hold a broom handle in both hands. With your arms at shoulder level, elbows straight and palms down, roll the broom handle backward in your hand. Do 3 sets of 10.
Written by Tammy White, IVIS, PT, and Phyllis Clapis, PT, DHSc, OCS, for RelayHealth
INJURY PREVENTION / PT
For Running:
- 1-leg total body rotation, side-side, and forward reach with weight/med ball
- 1 -leg squat (optional: foam pad or on Bosu, 180 deg toe touches)
- Neg rotation squat: inside, outside
- 1 -leg romanian dead lift (reach to 3 levels)
- Bosu balance 1-leg
- Straight-leg Band Sweeps: Post-chain, adductor, abductor
- Squat/leg press with toes in
- Lunges: multiple variations
- Lateral jumps on Bosu
- Jumping rope
- 1 -leg hop + reach (optional: on foam pad)
- 1 -leg ball toss
For Shoulder:
- External shoulder rotation with band (elbow 90 deg)
- Straight-arm lat pull with band
- Tennis backhand with band
- Close-grip row
- Lying shoulder rotation with DB
- Overhead ball bounce on wall
- Scapular pushups
- Scapular retractions w/ bands (elbows in at sides)
SWIMMING-SPECIFIC
- DB bench press: all angles
- Lat Pull down (2 arm, 1 arm)
-Row: all angles
- Straight arm lat pull down
- Forearm curls
- Tri Kickback, or Tri Pull down
- Abs: Curls, Rotation, overhead extension reach, leg extension
- Back Extension, and with rotation
- Arm extension on Swiss ball: Y, T, I
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