Not just tennis
You may well be puzzled. Your doctor has told you that you’ve got a ‘tennis elbow’, yet you might never have held a tennis racquet in your life!
In fact, the ailment is caused by a physical strain. Of course, a strenuous game of tennis can be the cause, but it can also be any one of a number of activities. People who are continually gripping and twisting – carpenters and plasterers, for instance – are particularly prone to this painful condition.
The medical name for tennis elbow is ‘lateral epicondylitis’. The lateral epicondyle is the bony part you can feel on the outside of your elbow joint (see Figure 1). It is outside the joint and so is unaffected by arthritis or deformity, but it is often prominent, especially in thinner people, and consequently it can easily be knocked, which causes soreness and bruising.
A similar condition to tennis elbow can occur on the medial (inside) epicondyle, commonly known as the ‘funny-bone’. This has been called ‘golfer’s elbow’, although, again, it is by no means confined to those who play golf.
What is the cause?
Tennis elbow usually arises when the tendons coming from the muscle of the forearm become inflamed at the point where they join the epicondyle. Although it is painful it is not damaging, and there are usually no long-term effects.
This condition can be readily diagnosed without the need of investigations. It can usually be treated by a GP without the need to go to hospital.
What are the symptoms?
Tennis elbow is uncommon in anyone under 40 or over 60 years of age. Different people experience varying degrees of pain, ranging from a mild discomfort when the arm is used to an ache severe enough to prevent you sleeping. The pain is made worse by gripping or twisting movements. The lateral epicondyle will feel tender, particularly if you catch your elbow.
Repeated movements of the wrist, especially those meeting resistance, such as a backhand tennis stroke, will make matters worse.
The same might happen if you are using a paint-roller on a ceiling. This is because those tendons that enable you to stretch back your fingers and wrist (known as the extensor tendons) all come together and are fixed into the lateral epicondyle. Lifting heavy weights at work or at home can make it worse.
Also, you may well notice some pain further down your forearm. You should not have any tingling in the arm or fingers – this would indicate some other condition, such as pressure on the nerve in the neck (cervical spondylosis) or at the wrist (carpal tunnel syndrome).
Normally there should be no swelling around the elbow joint itself, though occasionally the localised tender areas might show some. You may be asked to go for x-rays or blood tests, but these will be quite normal in tennis elbow as it is not a form of arthritis.
What is the treatment?
The condition is likely to get better by itself if you cut out excessive or repetitive movement of the elbow and hand.
Some people find warmth (from a hot-water bottle, for example) helps. Others find that a cold ice-pack (such as a packet of frozen peas wrapped in a towel) placed on the tender area twice a day for 10 minutes is beneficial. Mild painkilling tablets from the chemist will also help. Many people get some benefit from anti-inflammatory gels rubbed into the painful area. Ask your chemist about these.
If the pain shows no sign of lessening your doctor may suggest a cortisone (steroid) injection into the tender area. There is little risk of the side-effects that some people suffer when steroids are taken by mouth, since the drug is injected only into the affected area and it represents only a small dose in relation to the body as a whole.
There is a slight possibility that the pain will actually become worse for a few hours after the injection. Occasionally the pain may be severe and last for up to 48 hours. A repeat injection may be necessary for persisting pain. However 75% of people recover after the first injection, though you may still be advised to rest your elbow for up to 2–3 weeks afterwards.
If the pain continues for a longer period physiotherapy might help ease the discomfort. Occasionally manipulation is advised in long-standing cases.
Rarely, an orthopaedic surgeon might be asked to relieve the condition by a minor tendon-releasing operation.
Various methods of strapping or splinting the forearm may be tried to relieve the strain on it. In particular, an ‘epicondylitis clasp’ may help if worn during activities that aggravate the pain.
The end in sight
If you are suffering from tennis or golfer’s elbow you will have to face the fact that you may be in pain for some time – perhaps as long as a year or more. But the good news is that the condition is what is known as ‘self-limiting’; this means it will get better on its own eventually.