You might have heard of the injury which is known as ‘tennis elbow‘. However, tennis elbow is a common injury which is not only limited to professional tennis players, as is generally thought to be the case. Tennis elbow is a surprisingly prevalent condition and affects between approximately 1% and 3% of the general population at any, one time. Unsurprisingly, approximately 5% of individuals with tennis elbow are professional racquet sports players. But what is tennis elbow, how is it diagnosed and finally, what are the causes?
What is tennis elbow?
Very simply, tennis elbow is a cause of elbow pain. Clinically, tennis elbow is called lateral epicondylitis. Your elbow joint links three different bones: the humerus (which is your upper arm bone); radius and ulna; both the radius and ulna are located within the forearm. Clinically, tennis elbow is known as lateral epicondylitis, due to the tendency of the elbow pain to occur on the lateral bony section of your outer elbow (the bottom of the humerus), which is known as your lateral epicondyle. Lateral epicondylitis occurs when the extensor tendons of the forearm, which have the main job of aiding the grip of objects, become inflamed due to overuse. Specifically, when your muscles (and specifically the extensor carpi radialis brevis muscle) and tendons are strained, tears and inflammation can occur near the lateral epicondyle of your elbow, resulting in the characteristic pain. As tennis elbow affects the tendons, it is a type of condition which is known as a tendinopathy. Lateral epicondylitis typically occurs in your dominant arm; in other words, if you are right-handed then symptoms of tennis elbow will occur in your right arm.
How is tennis elbow identified?
Tennis elbow is typically diagnosed due to the characteristic pain which occurs as a result of the injury. Pain is the most common symptom of tennis elbow, although this can vary dramatically in its nature, depending on the full extent of the injury. For example, the pain which accompanies tennis elbow can range all the way from a very mild sensation of discomfort, which can be felt when the elbow is being used normally (for example, such as twisting a jar), right the way up to extreme pain, even when the elbow is completely still. In some cases, the pain can be so extreme as to prevent everyday activities such as holding a cup, or opening a door handle. In some cases, bending the wrist backwards against force can also exacerbate the pain; this can include activities such as performing a backhand move when playing tennis, or even using a screwdriver normally. Some people might also notice that their grip is weaker than it normally is (and this is particularly noticeable when shaking hands) and that their elbow is also stiffer than normal. Due to the characteristic symptoms described, it is most common for individuals with tennis elbow to self-diagnose the condition; although, if required, the diagnosis can be confirmed by a general practitioner (GP) or physiotherapist, who will ask specific questions about your work, medical history and hobbies, as well as asking about potential causes of your symptoms. In some cases, your GP might advise you to have additional tests to rule out other causes of the pain. This might include an X-ray, which can differentiate tennis elbow from a broken bone or osteoarthritis. Alternatively, blood tests can ensure that the symptoms of tennis elbow are not due to rheumatoid disease, which is a tendency to affect multiple joints.
Most people will experience a stronger sensation of pain when the arm and elbow are being used; this is typically particularly noticeable when the arm is twisted. Additionally, people with tennis elbow tend to find that performing repetitive wrist movements can exacerbate the pain, including gripping objects and extending the wrist.
However, different people will experience different symptoms. Commonly, these will include pain and stiffness when the arm is completely extended; pain when the arm is being bent, or is being lifted, and pain felt on the outside of the upper forearm below the elbow. In some cases, people will experience the sensation of pain, travelling down the forearm, towards the wrist area of the arm. It is also common for people to experience pain when grasping small objects, such as a pen or coin, or when writing. As mentioned, pain felt when the forearm is being twisted is common. People also commonly report feeling pain when they are turning a door handle, or when they are opening a jar. It is most common for the symptoms of tennis elbow to gradually develop; and in most cases this will happen between 24 and 72 hours after the action or event which caused the symptoms. However, it is normal for people with tennis elbow to be completely unable to identify a specific event which caused the symptoms.
What are the causes of tennis elbow?
The characteristic inflammation of the extensor tendons observed in tennis elbow typically occurs due to the overuse of the muscles and tendons of the forearm. However, tennis elbow can also occur as a consequence of simply banging, or knocking, the elbow. Additionally, tennis elbow can even occur as a result of attempting a certain activity which the muscles are not used to. Tennis elbow is usually caused by any form of activity which requires the forearm and the repeated twisting of your wrist. Whilst racquet sports, including tennis, badminton or squash, is a risk factor for developing tennis elbow, it is not the only cause of tennis elbow. In the case of racquet sports, this can be caused by poor technique, or from gripping the racquet more tightly than should be done.
Other causes include throwing sports, such as repeatedly throwing the javelin; manual work, such as plumbing, or bricklaying; gardening (particularly when using shears); decorating, when a roller or paintbrush is being used; or other activities which require repetitive hand and wrist movements (for example, typing can cause tennis elbow) or activities which require the repeated bending of the elbow. Prolonged gripping can also cause tennis elbow; for example, this could include hammering, playing musical instruments, or weightlifting. Members of other professions also report tennis elbow due to the repetitive hand and wrist actions; this includes butchers, carpenters, chefs and individuals working in manufacturing. Tennis elbow is particularly common in individuals who are aged between 40 and 50 years of age.
The good news is that the majority of individuals who have tennis elbow (the most up-to-date figures suggest that this is approximately 90% of people with tennis elbow) will make a full recovery within twelve months. It is most common for the recovery from tennis elbow to last anywhere between six months and two years, as tendons recover and heal relatively slowly. During the recovery phase, tennis elbow will eventually get better on its own; rest is recommended in order to allow the tendons to recover and heal on their own. Additionally, the activity which caused the injury should be completely avoided during the recovery phase. However, in some cases when an occurrence of tennis elbow is left untreated, tennis elbow can become chronic.