Tennis Elbow – Diagnosis and Treatment
Tennis elbow affects the outer part of the elbow and causes pain and discomfort. This problem is common among tennis players, but it can affect anyone who uses their forearm muscles often in daily activities or work.
Overuse or repeated movement usually causes tennis elbow. These actions lead to small tears in the tendons near the elbow joint.
People often feel pain when lifting objects, shaking hands, or gripping something tightly. Regular tasks can become more difficult and uncomfortable for many people, not just athletes.
Diagnosis
Doctors typically begin diagnosing tennis elbow (lateral epicondylitis) by reviewing your medical history and conducting a physical exam. This condition is most often diagnosed clinically, meaning no lab tests are needed in most cases.
One of the key physical exam steps involves pressing on the outer part of your elbow (lateral epicondyle) to check for tenderness or pain. You may also be asked to extend your wrist or fingers against resistance to see if that reproduces symptoms.
These tests help pinpoint pain coming from the extensor tendons of the forearm—especially the extensor carpi radialis brevis (ECRB) muscle, which is commonly affected.
Common Evaluation Steps
- Reviewing symptoms such as elbow pain, grip weakness, or pain that worsens with activity
- Functional testing to provoke discomfort during wrist or finger movements
- Identifying risk factors such as repetitive motion (e.g., racket sports, typing, or manual labor)
Imaging and Further Testing
If symptoms don’t clearly point to tennis elbow—or if treatment hasn’t worked—doctors may order imaging tests like:
- X-rays – to check for bone abnormalities or arthritis.
- MRI or ultrasound – to detect tendon tears, degeneration, or inflammation.
- Electromyography (EMG) – in rare cases, to rule out nerve compression or other neurological issues that mimic lateral epicondylitis.
Treatment
Exercises and Support
Physical or occupational therapists often help when self-care does not bring relief. Therapists design routines to improve strength and flexibility in the forearm and surrounding muscles.
| Approach | Purpose |
|---|---|
| Strengthening exercises | Build muscle/tendon resilience |
| Forearm braces/straps | Minimize stress on the injury |
| Activity modification | Reduce risk of further damage |
| Guidance from therapist | Ensure safe, efficient movements |
These exercises help rebuild the tendons around the elbow. Special straps or braces can support the forearm and reduce strain.
These supports help limit stress on the injured area during daily movements. Changing how a person performs tasks—such as adjusting grip, posture, or equipment—can also help.
Injections, Procedures, and Surgery
If therapy and self-care do not relieve pain, doctors may suggest medical procedures:
- Injections: Doctors sometimes inject corticosteroids or platelet-rich plasma (PRP) into the affected area. In rare cases, they use botulinum toxin or sugar water (prolotherapy) to encourage healing.
- Dry Needling: Clinicians use a small needle to repeatedly puncture the damaged tendon. This action stimulates a healing response.
- Ultrasound-Guided Treatments: Some people receive needle fenestration or ultrasonic tenotomy. In needle fenestration, small needles are used under ultrasound to trigger healing. The TENEX procedure uses needles and ultrasonic vibration to break up unhealthy tissue, which is then removed.
- Shock Wave Therapy: In this noninvasive approach, clinicians direct targeted shock waves at the painful area to increase blood flow and speed up recovery.
- Surgical Intervention: If pain and weakness last for many months, surgeons may remove injured tissue. Surgeons can make one large cut (open procedure) or several small ones using a camera (arthroscopy). Sometimes, an endoscope guides the surgery with minimal cutting.
Lifestyle and Home Remedies
Managing tennis elbow at home can help reduce pain and swelling. Simple steps include resting the affected arm, using ice packs to ease inflammation, and taking over-the-counter anti-inflammatory medications.
Wearing a brace or splint may support the joint and protect it during movement. Gentle stretching exercises can improve strength and range of motion.
Getting Ready for Your Visit
Steps You Can Take
Preparing for an appointment can make the visit go smoothly. People should write down important details before meeting with their health care provider.
Key things to note include:
- The time when symptoms started
- Activities or movements that lessen or worsen the pain
- Any recent injuries to the elbow
- A list of all medications or supplements being taken
Bringing these notes can help answer questions quickly and ensure important information is not forgotten. Some people also find it helpful to bring a list of questions for the doctor.
A sample table for notes might look like this:
| Details to Write Down | Examples |
|---|---|
| Symptom Start Date | Two weeks ago |
| Activities That Affect Symptoms | Lifting, typing, sports, resting |
| Recent Injury | Fell on elbow last month |
| Current Medications/Supplements | Ibuprofen, multivitamin, fish oil |
Questions Your Provider May Ask
During the visit, the doctor or specialist will likely ask for specific details. Knowing what to expect can help a patient feel more comfortable.
Some possible questions include:
- Are there any conditions like rheumatoid arthritis or nerve problems?
- Is the job or daily activity heavy in repeated arm or wrist motions?
- Does the person play sports, and if so, which ones?
- Has anyone ever given feedback on the way sports or physical activity is performed?
The doctor may also perform a physical examination or ask about lifestyle habits. Honest and clear answers can help with diagnosis and treatment.
