By Dr. Jedediah W. Jones, M.D.
Tennis elbow is the common name for a painful condition of the elbow. It involves a tear or degeneration of one of the tendons that helps extend the wrist. (1) The tendon originates on a bony prominence on the outside of the elbow called the lateral epicondyle. Patients complain of pain on the outside of the elbow and forearm with repetitive gripping and grasping.
In 1882, the term "lawn tennis elbow" was used to describe pain in the elbow from doing too many backhands (2). However, only 5-10% of cases are caused by playing tennis. Most cases are caused by work related stresses in people 30-50 years of age. (3)
Nonetheless, tennis elbow does occur in tennis players. However, it is rare in young, experienced players. Older, less experienced players are more commonly affected. There are two reasons for this.
As we age, the amount of water in our tendons decreases. The tendons can become like rubber bands left out in the sun too long. They dry out. Repetitive stress and strain causes cracks to develop in the rubber band and it breaks. Similarly, repetitive gripping of the racquet and ball impact strains the tendon resulting in a tear. Most patients don't feel a single pop or snap. Most often the break is small and gradual. The tendon still functions because it remains adhered to surrounding tendons. Therefore, you can still extend the wrist but it causes pain in the elbow.
Second, less experienced players likely have issues with technique that the more experienced players do not have. For example, several studies suggest a link between tennis elbow and poor mechanics of the one-handed backhand. (3,4,5) With the forearm pronated and wrist flexed, many players lead with the elbow at ball impact. At follow-through, the wrist is rapidly extended. This places excessive strain on the tendon making it more prone to injury. Transitioning to a two handed backhand may lessen the strain. (5)
Making changes to your equipment can also help. Increased racquet vibration can make pain worse. Simple changes such as a larger, more cushioned grip, a larger racquet face, and tighter strings can relieve discomfort. (6)
The goal of treatment is to decrease pain until the tendon heals itself. This can take 6 months or longer. I believe that bracing and activity modification work well. Occasionally, I recommend a cortisone injection. This decreases pain temporarily. Other treatment such as ultrasound, shock-wave therapy, and lasers, are heavily marketed, but have not proven more effective (2). Surgery is reserved for patients that have incapacitating pain despite 6 months or more of non-surgical treatment. This involves removing the degenerative torn tissue and repairing the tendon tear. Results of surgical management are good in my experience.
Tennis elbow represents a tear or degeneration of the central wrist extensor tendon. Older, less experienced tennis players are more susceptible. Although symptoms may last for a long time, simple changes in technique and equipment can decrease pain and lessen the chance of injury. Ask your orthopaedic specialist and your tennis pro for ways to help.
1.Nirschl RP, Pettrone FA. Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surg 1979;61A:832-9.
2.Faro F, Wolf JM. Lateral Epicondylitis: Review and Current Concepts. J of Hand Surg 2007;32A:1271-79.
3.Boyer MI, Hastings H. Lateral tennis elbow:"Is there any science out there?" J Should and Elbow 1999; 8(5): 481-90.
4.Blackwell JR, Cole KJ. Wrist kinematics differ in expert and novice tennis players performing the backhand stroke: implications for tennis elbow. J Biomech 1994;27 :509-
5.Giangarra CE, Conroy B, Jobe FW, et al. Electromyographic and cinematographic analysis of elbow function in tennis players using single and double-handed backhand strokes. Am J Sports Med 1994; 21:394-9.
6.Hatze H. The effectiveness of grip bands in reducing racquet
vibration transfer and slipping Med Sci Sports Exert 1992;
Dr. Jedediah Jones is a board certified orthopaedic surgeon with Hand Surgery Specialists of Nevada. He is fellowship trained and has added qualification in the management of hand, wrist and elbow injuries in children and adults. Visit their practice's website at hssnv.com for additional information about this or any other condition. Dr. Jones can be reached at (702) 645-7800.