Tennis elbow

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Tennis elbow is a condition where the outer part of the elbow becomes painful and tender, usually as a result of a specific strain or overuse. Although it is called “tennis elbow”, it should be noted that it is not restricted to tennis players. If one hyperextends an elbow in any sport, this may be classified as tennis elbow. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to tennis elbow. The condition was first described in 1883.^[1]. The medical term is lateral epicondylitis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Term “lateral epicondylitis” is a misnomer because, pathologically, this condition consists of mucoid degeneration with a paucity of acute or chronic inflammatory cells.

With tennis elbow, extensor carpi radialis brevis tendon of the extensor carpi radialis brevis muscle has been identified as the primary site of pathological change. There have also been pathological changes found at the extensor digitorum communis, longus and ulnaris tendons. The extensor carpi radialis brevis has a small origin and does transmit large forces through its tendon during repetitive grasping. It has also been implicated as being vulnerable during shearing stresses during all movements of the forearm.

There is no evidence relating mode of onset to pathology although it is generally acknowledged that tennis elbow is caused by repetitive microtrauma/overuse.

Inflammatory changes have been noted in the acute stages of the condition but have been found to be absent if symptoms become chronic (3 months +). This may explain why approaches such as corticosteroid injections have little impact in the chronic stages of the condition.

Although the name suggests otherwise tennis elbow can affect anyone not just racquet sport players although there are numerous studies that have implicated racquet sports as a cause or contributing factor for tennis elbow. The peak incidence is between 34 to 54 years of age. No difference in incidence between men and women or association between tennis elbow and the dominant hand has been demonstrated. A weak association has been found between work and tennis elbow development.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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The part of the muscle that attaches to a bone is called a tendon. When these muscles are used over and over again, small tears develop in the tendon. Over time, this leads to irritation and pain where the tendon is attached to the bone.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differential diagnosis for tennis elbow includes

• Anconeus compartment syndrome
• Bursitis
• Cervical radiculopathy
• Radio-humeral joint dysfunction
• Hypothyroidism
• Lateral epicondyle avulsion
• Musculocutaneus nerve entrapment
• Non-union of radial neck fracture
• Osteoarthritis
• Posterior interosseous syndrome
• Posterolateral rotatory instability
• Radial nerve tension
• Radial tunnel syndrome
• Rheumatoid arthritis
• Strained lateral collateral ligaments
• Snapping plica syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Lateral epicondylitis typically occurs in the 4th and 5th decades.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Risk factors for this condition vary from taking up tennis later in life, unaccustomed strenuous activity, decreased reaction times and speed and repetitive eccentric muscle contractions (controlled lengthening of a muscle group).

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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• Failure to improve with nonsurgical or surgical treatment. This may be due to nerve entrapment in the forearm
• Recurrence of the injury with overuse
• Rupture of the tendon with repeated steroid injections

Most people improve with nonsurgical treatment. The majority of those who do have surgery show an improvement in symptoms.

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