Brief overview
- Treatment: Immobilization, relief, cooling and later possibly warming, special bandage and medication, stretching and strengthening exercises, etc., in some cases surgery.
- Symptoms: Among other things, pressure pain on the outside of the elbow, joint can not be stretched completely, movement pain
- Causes and risk factors: Overuse on the outside of the elbow
- Diagnostics: Among other things, doctor-patient consultation, various tests (movement and grip tests), X-ray, magnetic resonance imaging, ultrasound
- Course of disease and prognosis: Lengthy healing process, but good chances of complete recovery
- Prevention: Strengthen arm muscles through regular exercise, regular breaks from monotonous movements, etc.
What is tennis elbow?
Tennis elbow or tennis elbow (technical term: epicondylitis humeri radialis, epicondylitis humeri lateralis) is a painful overuse of certain tendons in the elbow area (tendon insertion inflammation). Despite the name, tennis elbow does not only occur in tennis players.
How to treat tennis elbow?
What helps against tennis elbow? There is no generally accepted uniform approach to tennis elbow treatment that has been scientifically proven to promise the best therapeutic success.
However, experts advise that the first thing to do is to eliminate the cause of the overuse: The doctor immobilizes the tennis elbow for about two weeks so that the patient can rest it. Conservative measures such as cooling and, if necessary, painkillers alleviate the symptoms.
It may be advisable to wear a special bandage or a so-called epicondylitis brace, a type of pressure bandage. Other possible therapeutic measures include ultrasound treatments and stretching and strengthening exercises. In severe cases, when conservative tennis elbow treatment does not help sufficiently, surgery may be necessary.
You can read more about the various therapy options for tennis elbow below:
Treating tennis elbow with conservative measures
If necessary, you will receive a sick leave from your doctor after the diagnosis of tennis elbow. The duration of the sick leave depends on the symptoms and the healing process.
For the time after recovery, it is important to correct the movement patterns that presumably triggered the tennis elbow: This can be achieved, for example, by adapting the workplace (ergonomic computer mouse) or technique training (for example, tennis stroke technique).
Stretching and strengthening: In the course of tennis elbow treatment at home, experts recommend stretching and strengthening the arm muscles – but only when you no longer experience severe pain when performing the exercises. Targeted strength training in particular may be helpful in the early stages of the condition: according to experts, this reduces the blood flow to the relevant area, causing the pain to subside.
Discuss such exercises with your physical therapist or doctor beforehand and have them show you how to do them correctly.
Physical therapy: It is also possible to treat tennis elbow with physical therapy measures. Suitable treatments for tennis elbow include massages of the wrist muscles and heat or cold treatments.
Incidentally, whether it is better to cool or warm tennis elbow depends on the stage of the injury: In the acute stage and after intense exertion, cold has a soothing effect (apply ice wrapped in towel for 20 to 30 minutes, take a break for an hour, repeat). In contrast, heat is much more beneficial for tennis elbow in the chronic stage.
Bandages: If the symptoms are pronounced, it is possible for those affected to wear a tennis elbow bandage (epicondylitis brace) over the elbow and wrist for a few weeks. It is available in some sports stores or medical supply stores.
Instead of a bandage, immobilization in the case of tennis elbow may be achieved with a plaster splint.
The pad ideally sits about five centimeters below the elbow joint. A finger usually fits between the arm and the pad.
Taping: Tape bandages and so-called kinesiotapes may also be used as part of tennis elbow treatment. Appropriate instructions on the Internet help to properly tape tennis elbow. However, taping is less complicated and more professionally done by your physiotherapist.
Medication: Doctors often use anti-inflammatory medication to treat tennis elbow (either applied locally, for example, in the form of gel, ointment or to take). In addition to the classic rheumatism drugs (anti-inflammatory drugs), there are various painkillers, drugs for muscle relaxation, herbal preparations, enzymes and nucleotides. Your doctor will explain to you which preparations are appropriate in each individual case.
Transcutaneous electrical nerve stimulation (TENS): TENS is a gentle form of electrotherapy and is also called stimulation current therapy. It involves delivering mild electrical pulses to pain-conducting nerve fibers. This potentially inhibits the transmission of pain stimuli and thus the discomfort.
Infiltration therapy: Some doctors inject patients with tennis elbow with a local anesthetic to interrupt nerve conduction in the affected area to relieve pain. Anti-inflammatory cortisone may also be used. It is also possible to inject the nerve toxin botulinum toxin at the main pain point and into the affected muscles. This “paralyzes” the muscles for a few months so that they can recover.
Other treatment options for tennis elbow include extracorporeal shock wave therapy (pain relief through externally generated pressure waves), X-ray stimulation radiation (for anti-inflammation and pain relief) and laser treatment. However, their effectiveness for tennis elbow has only been proven by a few studies.
Tennis elbow surgery
Such an intervention achieves good results in most cases. However, it is only advisable in severe cases when conservative treatment over several months has not been successful. For example, tennis elbow surgery is indicated in cases of long-lasting and very severe pain that restricts daily life. Surgery may also be necessary for patients who have concomitant injuries in addition to tennis elbow.
Tennis elbow & homeopathy
Some patients with tennis elbow treat their symptoms with home remedies or homeopathic remedies as a supplement to conventional medical measures, although their effectiveness is controversial. For example, Arnica is said to help against acute inflammation and pain in tennis elbow.
If the pain subsides with light movement, Rhus toxicodendron is often recommended. If, on the other hand, every movement hurts, Bryonia is said to be more suitable. In addition, Ruta is considered a proven remedy for tendon and periosteum injuries.
The concept of homeopathy and its specific effectiveness are controversial and not clearly proven by studies.
How does tennis elbow manifest itself?
Another possible tennis elbow symptom is a feeling of weakness in the wrist. Strong pulling, a strong fist grip, a strong grip when shaking hands or holding a cup are then often no longer possible.
Here is a summary of typical tennis elbow symptoms:
- Gentle posture – it is not possible to straighten the elbow
- Pressure pain on the outside of the elbow
- Pain on movement
- Weakness in the wrist
- No strength to make a fist
- Tingling in the hand
Tennis Elbow: Causes and Risk Factors
The cause of tennis elbow is overuse in the outer part of the elbow. Stressful, repetitive movements or a sudden increase in strain without adequately prepared muscles cause microscopic tears in the tissue.
Tendons and fibrocartilage are most susceptible to such minute injuries (microtraumas). The resulting pain may radiate into the upper or lower arm. Basically, the following risk factors favor tennis elbow:
Weak forearm muscles as well as older age (decreasing tendon elasticity!) additionally favor micro injuries in the elbow area and thus tennis elbow.
(Previous) diseases and treatments: Sometimes previous diseases are the cause of tennis elbow. This is, for example, a previous accident or a joint disease. Previous conservative or surgical treatment in the elbow area also increases the risk of tennis elbow.
Tennis elbow is most common in people in their fourth decade of life.
Golfer’s Elbow
As with tennis elbow, overuse due to repetitive motion patterns is the trigger for discomfort in the arm area in golfer’s elbow. However, while tennis elbow affects the outside of the elbow, golfer’s elbow (epicondylitis humeri ulnaris), which is much less common, causes symptoms on the inside of the elbow.
Like tennis elbow, golfer’s elbow affects not only a specific group of athletes (golfers), but also, for example, gymnasts, throwing athletes, and strength athletes during free weight training, if they want to compensate for a lack of technique by using strength.
Learn more about how to recognize golfer’s elbow and what can be done about it in the article Golfer’s Elbow.
Examination and diagnosis
Which doctor is the right person to contact in case of tennis elbow? If you suspect tennis elbow, for example, your family doctor is the right person to contact. Some patients also go directly to a specialist in orthopedics.
The doctor will first talk to you in detail to take your medical history. If tennis elbow is suspected, this is followed by a physical examination with various tests. To rule out other causes for the pain, he or she will resort to imaging tests (such as X-rays).
Medical history
In the anamnesis interview, the doctor asks about the exact symptoms, any injuries or previous illnesses, and possible triggers for the symptoms. This information helps the doctor narrow down the cause of the symptoms. Possible questions include:
- Did you injure your arm, perhaps from a fall?
- Have you had previous arm discomfort for no apparent reason?
- Where exactly do you feel pain?
- Is it a pain on movement or at rest?
- Does the arm or hand feel powerless because of the pain?
- What do you do for work? What sports do you play?
Physical examination and tests
After the patient interview, the doctor will examine your arm. Even at first glance, he or she may notice that the arm is already in a resting position: Many patients with tennis elbow instinctively hold the elbow still and avoid extending the forearm completely. For more precise clarification, the doctor palpates the elbow and checks whether certain areas react with pressure pain.
So-called provocation tests are also important for the diagnosis: the doctor asks you, for example, to stretch the hand in the wrist against resistance (i.e. to move the back of the hand in the direction of the forearm). This causes pain in tennis elbow because the extensor carpi radialis brevis muscle is usually affected.
Often the superficial extensor of the forearm (M. extensor digitorum communis) is also affected by tennis elbow: In this case, it hurts when the middle finger is extended against resistance.
The chair test is also informative: with your arm outstretched and your forearm turned inward, lift a chair by its back with one hand. This is very painful in the case of tennis elbow.
To rule out other possible causes for the discomfort of the supposed tennis elbow, the doctor also examines your cervical spine, shoulder and hand and assesses blood flow, motor function and sensitivity (including nerve constriction signs) in the affected arm.
Imaging examinations
With the help of an X-ray, the doctor is able to rule out some other potential causes of elbow joint pain, such as osteoarthritis. In tennis elbow, the x-ray is usually unremarkable. In some patients, calcification of the tendon insertion may be visible – but this does not influence the course of the disease.
Course and prognosis
The prognosis for tennis elbow is good. However, treatment may be protracted. For those affected, this means being prepared for several months of painful movement and stress impairments.
In many cases, conservative treatment with medication, physiotherapy and infiltration therapy is sufficient. Surgery is only necessary if other therapeutic approaches have no effect and/or the patient has severe symptoms over a longer period of time.
In general, the following applies to tennis elbow: The earlier you start therapy, the greater the chances of success. It is also important to carry out the therapy consistently, otherwise the pain may become more severe and even chronic (chronic tennis elbow).