How to Treat Tennis Elbow

Tennis elbow, also known as lateral epicondylitis, is a common condition that causes pain in the elbow. While often associated with tennis, anyone who performs repetitive arm motions can develop this condition. Fortunately, most cases of tennis elbow can be effectively managed with various treatments and self-care strategies. This article will explore How To Treat Tennis Elbow, from initial diagnosis to long-term management.

Diagnosing Tennis Elbow

The first step in treating tennis elbow is getting an accurate diagnosis. Often, your healthcare provider can diagnose tennis elbow through a thorough medical history review and a physical examination. During the physical exam, they will likely:

• Palpate the affected area: Your doctor will gently press on the outside of your elbow where the tendons of your forearm muscles attach to the bone (lateral epicondyle). Tenderness in this area is a key indicator of tennis elbow.
• Assess your range of motion and pain triggers: You will be asked to move your elbow, wrist, and fingers in different directions. Specific movements that reproduce your elbow pain, such as extending your wrist against resistance, help confirm the diagnosis.

In most cases, medical history and physical exam are sufficient to diagnose tennis elbow. However, if your healthcare provider suspects another underlying condition might be causing your symptoms, they may recommend imaging tests such as:

• X-rays: These are primarily used to rule out arthritis or fractures in the elbow joint, as tennis elbow itself does not show up on X-rays.
• Sonograms (Ultrasound): Ultrasound imaging can visualize tendons and soft tissues, helping to confirm tendon damage or rule out other conditions like bursitis or ligament injuries.
• MRI (Magnetic Resonance Imaging): In rare cases, if the diagnosis is unclear or symptoms are severe and persistent, an MRI might be ordered to provide a more detailed view of the elbow joint and surrounding tissues.

Treatment Options for Tennis Elbow

Tennis elbow often improves with time and conservative treatments. The initial approach typically involves self-care measures and pain management. If these are not sufficient, a range of therapies and procedures are available.

Therapy

Therapy is a cornerstone of tennis elbow treatment, focusing on pain reduction, restoring function, and preventing recurrence. A healthcare professional, such as a physical therapist, occupational therapist, or hand therapist, can tailor a treatment plan to your specific needs. Therapy may include:

• Activity Modification and Ergonomic Advice: Identifying and modifying activities that aggravate your elbow pain is crucial. This might involve adjusting your tennis technique, workplace setup, or how you perform daily tasks. Therapists can analyze your movements and equipment to suggest changes that reduce stress on the injured tendon.
• Specific Exercises: Therapeutic exercises are designed to strengthen the forearm muscles, improve flexibility, and promote tendon healing. These exercises often include:
  • Stretching exercises: Gentle stretching of the wrist extensors can help improve flexibility and reduce stiffness.
  • Strengthening exercises: Exercises using light weights or resistance bands, focusing on wrist extension, flexion, and grip strength, gradually rebuild muscle strength.
  • Eccentric exercises: These exercises, which involve slowly lengthening the muscle while resisting a force, have been shown to be particularly effective for tendon rehabilitation.
• Bracing or Strapping: A forearm strap or brace worn just below the elbow can help redistribute pressure away from the injured tendon, providing support and pain relief during activities.

Surgical and Other Procedures

If conservative treatments, including therapy and home remedies, fail to provide adequate relief after several months (typically 6-12 months), your doctor might consider more invasive procedures. These procedures aim to stimulate healing or remove damaged tissue. Options include:

• Injections (Shots): Various types of injections can be administered into the affected tendon area.

  • Corticosteroid injections: These injections can reduce inflammation and provide short-term pain relief. However, they are not a long-term solution and may have potential side effects with repeated use.
  • Platelet-Rich Plasma (PRP) injections: PRP therapy involves injecting a concentration of your own platelets, which contain growth factors, into the damaged tendon to promote healing.
  • Botulinum Toxin A (Botox) injections: In some cases, Botox injections may be used to temporarily paralyze the forearm muscles, reducing stress on the tendon and allowing it to heal.
  • Prolotherapy: This involves injecting an irritant solution, such as dextrose (sugar water) or saline (salt water), into the tendon to trigger an inflammatory response that is thought to stimulate healing.
  • Dry Needling: This technique involves inserting thin needles into the damaged tendon multiple times to create micro-trauma and stimulate a healing response.

• Needle Fenestration: Guided by ultrasound imaging, a needle is repeatedly inserted into the numbed tendon to disrupt the damaged tissue and initiate a new healing process.

• Ultrasonic Tenotomy (TENEX Procedure): Similar to needle fenestration, this minimally invasive procedure uses ultrasound guidance to deliver ultrasonic energy through a special needle. The energy liquefies and removes damaged tendon tissue.

• Extracorporeal Shock Wave Therapy (ESWT): This non-invasive treatment uses shock waves to stimulate healing in the injured tendon. A device applied to the skin delivers these shock waves to the affected area.

• Surgery: Surgery is typically considered as a last resort for tennis elbow that has not improved after 6 to 12 months of comprehensive non-surgical treatment. Surgical options include:

  • Open surgery: This involves a larger incision to access and remove damaged tendon tissue.
  • Arthroscopic surgery: This minimally invasive approach uses small incisions and a camera to guide the surgical removal of damaged tissue.

Regardless of the chosen procedure, rehabilitation exercises are essential after any invasive treatment to regain strength, flexibility, and full function of the elbow.

Lifestyle and Home Remedies

In addition to professional treatments, several self-care measures can help manage tennis elbow symptoms at home:

• Rest: Avoid activities that worsen your elbow pain. This doesn’t necessarily mean complete immobilization, but rather modifying or temporarily stopping activities that strain your elbow.
• Pain Relievers: Over-the-counter pain medications such as ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve) can help reduce pain and inflammation. Follow the dosage instructions on the packaging.
• Ice: Apply ice packs or cold compresses to the elbow for 15-20 minutes at a time, 3-4 times a day. Ice helps to reduce pain and inflammation, especially after activity.

Preparing for Your Doctor’s Appointment

If you are experiencing persistent elbow pain and suspect you might have tennis elbow, it is important to consult your healthcare provider. To make the most of your appointment, consider the following:

What You Can Do:

• Symptom History: Be prepared to describe when your symptoms started, the location and intensity of your pain, and what activities make your pain better or worse.
• Injury Information: Think about whether you have recently injured your elbow, even if it was a minor incident.
• Medication List: Bring a list of all medications and supplements you are currently taking.
• Questions to Ask: Prepare a list of questions for your doctor, such as:
  • What is the most likely cause of my symptoms?
  • What treatments are available?
  • What are the potential risks and benefits of each treatment option?
  • How long will it take for my elbow to heal?
  • What can I do at home to manage my symptoms?

What to Expect From Your Doctor:

Your doctor will likely ask you questions to understand your condition better, such as:

• Medical History: They may ask about pre-existing conditions like rheumatoid arthritis or nerve diseases, which can sometimes mimic tennis elbow symptoms.
• Occupational and Sports Activities: Be prepared to discuss your job duties, especially if they involve repetitive wrist or arm motions. If you play sports, they will ask about the types of sports and your training habits.
• Pain Triggers: Your doctor will want to know what specific motions or activities aggravate your elbow pain.

By being well-prepared for your appointment, you and your healthcare provider can work together to develop an effective treatment plan for your tennis elbow and get you back to pain-free function.

References:

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4. Jayanthi N. Elbow tendinopathy (tennis and golf elbow). https://www.uptodate.com/contents/search. Accessed Feb. 7, 2023.
5. Ferri FF. Epicondylitis. In: Ferri’s Clinical Advisor 2023. Elsevier; 2023.
6. The evolving use of extracorporeal shock wave therapy in managing musculoskeletal and neurological diagnoses. Mayo Clinic. https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/the-evolving-use-of-extracorporeal-shock-wave-therapy-in-managing-musculoskeletal-and-neurological-diagnoses/mac-20527246. Accessed Feb. 8, 2023.
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