What Is Tennis Elbow?

Tennis Elbow, which technically is call lateral epicondylitis of the elbow, is a partial tearing of the tendon where it attaches to the elbow.

Tennis Elbow is on the outside part of the elbow and what we call Golfer’s Elbow, for comparison sake, is on the inside part of the elbow.

The muscles that attach there on the outside for Tennis Elbow are the wrist extensors. So when you bring your wrist up to the ceiling those muscles start as tendon attached to the bone at the outside part of your elbow. The problem really relates to overuse of the wrist extension which is why we see it in tennis players such as in back hand swing.

People playing a lot of tennis can get Tennis Elbow. The truth is mostly people who don’t play tennis are the ones getting tennis elbow. It’s pretty rare in professional tennis players to ever get tennis elbow because they play three or four times a week and don’t suddenly go and play for the weekend and develop these problems.

Most of the people I see this are the weekend warriors who say “Oh, let me go play with my friend for two hours.” But they haven’t played tennis for four weeks or five weeks. And then their arm is killing them because they have overused it. So that’s what causes tennis elbow.

Golfer’s Elbow is similarly on the inside and that’s due to your swing and you’re flexing the wrist rather than extending the wrist and that’s where the muscles attach on the inside part of the elbow.

Both can be severely painful – any time you try and move the elbow or move the wrist or try and lift something causes severe pain. It’s very easy to diagnose, if you know what to look for, where it’s pain in a specific spot.

The main thing to watch out for is you don’t miss a diagnosis of something else that’s going on such as an ulnar nerve problem which will cause tingling into your fingers (into the little finger or the ring finger). The ulnar nerve sits right next to the elbow and can have irritation or even severe injury to it and you don’t want to miss that.

Treating Small Tendon Tears

The tears that occur in tennis elbow and golfer’s elbow, these tears are micro tears. If it was a big tear it would probably bleed and scar and then heal. So if the tear is too small, where it doesn’t cause enough damage to get healing, what you want to do is first treat it with physical therapy.

Physical therapy is strengthening the adjacent muscles and resting these tendons where they have these micro injuries. If therapy doesn’t help, and it does help out 90 to 95% of people, then I consider a cortisone injection.

Cortisone is a great anti-inflammatory. You give that injection and it helps to cool down the area where the irritation is, get rid of some of the pain, and hopefully the physical therapy at that point can cure the person’s problem and pain in that area. If the therapy doesn’t help and the injection doesn’t help then we consider surgery. But again, it’s less than 5% of people that require surgery for that. The surgery itself takes about 20 minutes. And it’s in and out the same day. It’s not a big surgery.

But, my last choice is to do surgery, unless you really need it.

Who Does Tennis Elbow Affect?

Tennis elbow, and even Golfer’s Elbow, is pretty rare in someone less than 20 years old.

Typically I see it in people 20 years old to about 60 years old.

Occasionally I do see it in older people, but it’s typically the range of about 20 to 60 years old.

Weakness In Muscles and the Importance of Stretching

Weakness of those muscles, to the extensor muscles on the outside part of the elbow have not been used enough and then you try and overuse them and that causes these micro tears.

Tennis Elbow could also be related to tightness of those muscles, which is why it’s important to stretch and warm up before you do any athletic event. Even something as as low impact as tennis. So it’s really important to get your body warmed up. Jump on a bike, jog around a little bit, and stretch out your arms and your legs.

For Tennis Elbow you really wanna stretch your elbow and your wrist. If you’re warming up and your muscles are being used three times a week, it’s very unlikely to have an injury, but it can happen. If you’re someone who is very tight and doesn’t stretch and just plays and not that often, you’re much more likely to have a problem such as Tennis Elbow.

If Tennis Elbow Is Left Untreated…

Some patients who don’t get treated quickly, the pain can get so bad that they can’t use the arm at all. The elbow is one of those very unforgiving joints where if you don’t keep your motion it gets stiff and you can lose motion permanently in your elbow.

People will say, especially if their dominant arm get tennis elbow, “I can’t lift, can’t open a jar, sometimes can’t turn a door knob.”

A lot of people come in saying “I can’t shake hands.” And a lot of businessmen I see have a real problem because part of business is shaking hands with people. And if they can’t shake hands it affects their daily activities and their work.

So it’s really important to address it early on. And if someone comes in to me early I can usually get them better pretty quickly. But if I have patients who have this going on for several months, it takes much longer to get better.

Tennis Elbow Surgery

The surgery for tennis elbow takes about 20 minutes. It’s about a three centimeter incision, which is relatively small – maybe a one to two inch incision. And you go in, split the muscle, go to where the tendon has these micro tears, take out the damaged portion of the tendon, scrape the damaged bone in that area, maybe put some drill holes in it to help it to heal, and then just close it back up.

Tennis Elbow surgery tends to be successful in 80 to 90% of people. It’s not 100%, but it is very successful. And that’s why we reserve the surgery for people who just have not gotten better with other treatment.

It’s all an outpatient procedure so people go home the same day. You’re in a sling for a week or so and then you start therapy and exercises afterward. It’s very important to get the elbow moving early, but we do protect it for a week or so to help it heal.

Tennis Elbow Pain Treatment

When someone comes in that they’re having pain the anti-inflammatories are very effective for Tennis Elbow and for Golfer’s Elbow.

For example ibuprofen, Motrin, Aleve, any of those medicines usually help a lot. That’s the first line of treatment along with the physical therapy is anti inflammatories as needed.

People need to realize that, although it’s over-the-counter medicine, there are still some side effects and problems to taking Advil or Aleve where you can get stomach ulcers or ulcers in your upper GI track. You want to be careful how much you take and how often you take it.

One of the things which is very important, and physical therapists do this, and you should do it on your own, is after you exercise if anything is sore, put ice on it for 10 to 15 minutes. That will dramatically decrease the inflammation that develops and get rid of a lot of the pain that would have developed.

If you’re having a little bit of soreness in a joint, especially an elbow, after you workout and it’s a little sore, just ice it for 10 minutes and you’ll feel a lot better the next day.

Tennis Elbow PRP Injections for Healing

Something else that we do in my office is PRP injections which is an injection of your own blood that’s spun down and taking out the components that help get the growth factors to help healing.

We also do these occasionally for arthritis. All these injections are done under ultrasound guidance to make sure that we put the injection where it needs to go. There are some doctors out there who don’t use ultrasound guidance and I think that’s a mistake.

The ultrasound is the same thing that is used when a woman is pregnant. However this is an ultrasound especially designed to look at muscles, tendons and bones. We use the ultrasound to guide where the needle is when we’re doing a PRP injection. That allows really accurate placement of the needle.

Additionally what’s nice is if someone has swelling, we can drain it and at the same time we see the fluid very well in the ultrasound and it shows us where we want to inject making it highly accurate.

Common Causes of Tennis Elbow

The most common cause for these elbow pains are repetitive activities.

It can be from tennis but I do see it in baseball players too. I see it in people who are just working too much at their desk and doing a lot of lifting. I see it in people who are doing a lot of lifting at home, which is very common.

People who are moving often have injuries to their back, their knees and their elbows just from repetitive lifting of heavy boxes. I think because sometimes a box is not balanced well your elbow can get twisted and that causes also more subtle pain in Tennis Elbow.

Dr. Rick Weinstein, MD, MBA is an orthopedic surgeon specializing in sports medicine. He is the Director of Orthopedic Surgery at Westchester Health Associates and has subspecialty training in knee and shoulder surgery, including minimally invasive surgery and arthroscopy. Dr. Weinstein is a Board Examiner for the American Board of Orthopedic Surgeons, determining certification for other orthopedic surgeons.

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