Tennis elbow

Tennis elbow is a common condition that causes pain in the outer elbow.

Doctors often refer to this condition by its formal name, lateral epicondylitis. It is technically an enthesopathy, which is a disease that affects an attachment point where tissue meets bone. Specifically, it involves the origin of the extensor carpi radialis brevis muscle on the lateral epicondyle. This is the bony bump on the outside of your elbow. The condition matters because the pain can be quite severe and persistent. It can impact a person's ability to perform daily tasks or hold objects.

The mechanism of this pain involves the way muscles and tendons interact. The extensor carpi radialis brevis is the muscle most commonly affected. This muscle helps you move your wrist. Because of its unique position, its tendon is prone to abrasion during elbow movements. This can lead to repetitive microtrauma, which are tiny injuries to the tissue. Some researchers believe the condition is like a pressure sore. They suggest an initial microscopic tear occurs from a strain. If a person sleeps in a position that puts pressure on that spot, it may prevent the injury from healing.

Medical experts have debated how to best describe this condition. For a long time, the term lateral epicondylitis was the most common. However, the suffix "itis" implies inflammation. Studies have shown that this condition is not actually an inflammatory process. Instead, it involves tendinosis, which is a degenerative condition. In tendinosis, the body replaces normal tissue with a disorganized arrangement of collagen. Because of this, many prefer the term lateral elbow tendinopathy. In 2019, a group of international experts suggested this as the most appropriate name. Some also call it an enthesopathy because it affects the enthesis, or the attachment point.

Doctors use clinical evaluations to diagnose the condition. They look for specific signs, such as tenderness at the origin of the extensor carpi radialis brevis. A common method is called Cozen's test. During this test, a patient performs a resisted wrist extension with their elbow extended. If this movement triggers pain at the lateral aspect of the elbow, the test is considered positive. While medical imaging like X-rays, ultrasound, or MRI can show changes in the tendon, they are not usually necessary for a diagnosis. X-rays might show calcification, while an ultrasound can reveal thickening or tears in the tissue.

There are several phases of pain that patients may experience. In Phase I, pain is mild and occurs only after activity. It usually recovers within 24 hours. By Phase V, the pain is harmful and occurs during daily activities. It has a great negative impact on performance. In the most severe stage, Phase VII, the pain is consistent even at rest. This stage can disturb sleep and is aggravated by any activity. Most untreated cases of this enthesopathy will resolve within one to two years. However, the intensity of the pain can significantly change a person's quality of life.

Treatment focuses mostly on non-operative care, which helps about 90% of patients.

One method is the RICE method, which stands for rest, ice, compression, and elevation. Physical therapy is also common. This includes stretching the muscle with a straight elbow or using isometric strengthening. You can perform isometric exercises by pushing the top of your hand against a table.

Orthoses, or supportive devices, can also be used. A counterforce orthosis is a strap that applies binding force over the muscle origin. A wrist extensor orthosis keeps the wrist in slight extension to reduce strain.

Medication is another way to manage the symptoms. Topical nonsteroidal anti-inflammatory medications can be effective within four weeks. Some doctors use corticosteroid injections for short-term relief. However, the use of these injections is debated. Recent studies suggest they might actually delay how quickly symptoms go away. Repeated injections can even lead to muscle atrophy or tendon rupture. Therefore, clinicians must be cautious when using them. To prevent the condition, it is best to modify activities. Avoiding repetitive motions and heavy lifting with extended arms can help protect the elbow.