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January 08, 2012

Hand Surgery #7: Tennis Elbow

Tennis elbow is a painful disorder of the side of the elbow.  The medical name is lateral epicondylitis, but both names are incorrect!

  • Tennis elbow is not more common in tennis players,
  • and lateral epicondylitis is not an -itis (an inflammatory condition) but is instead a degenerative problem....



The medical name for tennis elbow, lateral epicondylitis, explains much about the anatomy.

  • Lateral means "on the side," and refers to the area of the elbow away from the body.
  • The humerus is the large upper arm bone, between the shoulder and the elbow.
  • At its distal end, the humerus has rounded bony protrusions on both sides of the elbow that are called epicondyles.
  • The lateral epicondyle, then, is the outer prominence of the humerus at the elbow.
  • The muscles that extend the wrist and fingers mainly originate from the lateral epicondyle.


Pathology - Tennis Elbow

Tennis elbow is a degenerative or traumatic tear of the extensor tendon origins at their attachment to the lateral epicondyle bone.  This causes pain on the outside of the elbow. When the injury does not heal normally, it becomes a chronic condition. It is NOT an inflammatory condition.



Tennis Elbow is often caused by repeated straining of the muscles of the forearm that extend the wrist and fingers.

  • Activities that involve repeated twisting or extension of the wrist during work or hobbies may strain the muscle attachment at the bone on the outside of the elbow.
  • In addition, carrying or pulling a heavy load with the elbow extended and the palm towards the floor may also cause a tear in the tendon origins.
  • In rare instances, a direct blow to the elbow may cause this condition.

Most often, tennis elbow reflects an aging process occurring around or after age 40, when repair capability diminishes.

I usually try to rule out other possible causes of pain in this area. Frequently, I order X-rays to make sure that there is no arthritis of the elbow and no shoulder problems.  I will also examine you carefully to be certain that there is no pressure on the radial nerve in the region of the elbow, which is called radial runnel syndrome.


Signs and Symptoms

Examination of the affected elbow will usually reveal tenderness and discomfort when pressure is applied to this area. In the early stages, pain may only be experienced with sudden, forceful activities involving grasping, pulling, or carrying objects with the elbow extended.



  • Conservative treatment:
    • avoidance of activities that provoke further symptoms
    • wearing a splint to hold the wrist in extension
    • use of a counter-force brace to provide localized pressure on the extensor forearm muscles and to give support to the area
    • a therapy program for strengthening the muscles of the forearm
    • Non-operative recoveries usually take 6-12 months.
  • I rarely recommend surgery for tennis elbow--only when symptoms are particularly severe and/or longstanding....
    • outpatient
    • small incision on the outside of the elbow
    • remove degenerative tissue
    • possibly, release the origins of the extensor muscles
    • possibly, remove a small portion of the lateral epicondyle



Following surgery, the wrist and elbow may be immobilized by the use of a bulky dressing or splint for 2 to 6 weeks. Range of motion exercises are prescribed on an individual basis, followed by exercises designed to strengthen the muscles of this region. Depending on the patient's progress with strengthening, unrestricted use of the arm is usually possible at 3 months following surgery.

It may be necessary to alter daily activities, especially avoiding those activities involving repeated or prolonged grasping with the elbow straight, high force pulling, or carrying of objects with the palm down. If work activities demand these types of motion, it may be necessary to change the way these tasks are performed.

When playing racquet sports, careful consideration should be given to proper grip size, the composite of the racquet, as well as the size of the racquet's "sweet spot." Continuation of the prescribed flexibility and strengthening exercises is also important in preventing recurrence of injury.



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