The forearm muscles are attached to the outer part of the elbow by tendons known as lateral epicondylitis, also called tennis elbow. Specifically, when the wrist or hand are moved, it causes pain and inflammation in the elbow area. People who perform repetitive or forceful activities that involve their wrists and forearms, such as tennis players, carpenters, painters, or computer users, can develop lateral epicondylitis.
Overuse and strain of the forearm muscles and tendons are the main causes of lateral epicondylitis. These muscles and tendons help extend and stabilize the wrist and hand. But when they are overused or overused, they can develop small tears and inflammation, causing elbow and forearm pain and weakness.
Some factors that can increase the risk of developing lateral epicondylitis include:
Age: Lateral epicondylitis is more common in people between 30 and 50 years old, as the tendons tend to lose elasticity and strength with age.
Occupation: Jobs or hobbies that involve frequent or intense use of the wrist and forearm, such as carpentry, painting, plumbing, gardening, or playing musical instruments, can increase the stress on the elbow tendons.
Sports: Sports that require a lot of wrist and forearm movements, such as tennis, golf, squash, or bowling, can cause lateral epicondylitis, especially if the technique or equipment is not optimal.
Injury: A direct trauma or injury to the elbow, such as a fall or a blow, can damage the tendons and trigger lateral epicondylitis.
The main symptom of lateral epicondylitis is pain and tenderness on the outer part of the elbow, where the tendons attach to the bone. The pain may radiate to the forearm and wrist, and worsen with certain movements, such as:
Gripping or holding an object, such as a racket, a hammer, or a cup.
Extending or bending the wrist, such as when typing, writing, or turning a doorknob.
Lifting or carrying something, especially with the palm facing down.
Other symptoms of lateral epicondylitis may include:
Stiffness or reduced range of motion in the elbow, wrist, or hand.
Swelling or inflammation in the elbow area.
Weakness or numbness in the forearm or hand.
To diagnose lateral epicondylitis, a doctor will usually perform a physical examination and ask about the medical history and symptoms. The doctor may also order some tests, such as:
X-rays: X-rays can show the structure and alignment of the bones in the elbow, and rule out other conditions that may cause similar symptoms, such as arthritis or fractures.
Magnetic resonance imaging (MRI): MRI can provide detailed images of the soft tissues, such as the muscles, tendons, and ligaments, in the elbow. It can show the extent and location of the tendon damage and inflammation.
Ultrasound: Ultrasound can use sound waves to create images of the elbow structures. It can also show the blood flow and movement of the tendons in real time.
Electromyography (EMG): EMG can measure the electrical activity and function of the muscles and nerves in the arm. It can help determine if there is any nerve damage or compression that may contribute to the symptoms.
The treatment of lateral epicondylitis depends on the severity and duration of the symptoms, and the patient’s goals and preferences. The treatment options may include:
In addition to resting the affected arm and avoiding activities that aggravate the pain, you can use a splint, brace, or sling to immobilize and support the elbow.
Ice: Applying ice packs to the elbow for 15 to 20 minutes several times a day can help ease the pain and swelling. Wrapping the ice pack in a towel can prevent skin damage.
Wrapping an ice pack in a towel can prevent skin damage. Ice packs should be applied to the elbow for 15 to 20 minutes several times a dayy prescribe stronger painkillers, such as opioids, or inject corticosteroids or platelet-rich plasma (PRP) into the elbow to provide more relief.
Taking over-the-counter pain relievers such as ibuprofen, naproxen, or acetaminophen can help reduce the inflammation and painrevent further injury and restore the function of the elbow. A physical therapist can also use other modalities, such as heat, ultrasound, or electrical stimulation, to stimulate blood flow and healing in the elbow.
After six to 12 months of conservative treatments, surgery may be considered a last resort if they fail to provide adequate relief or improvement. There are a variety of surgical options available depending on the extent and location of tendon damage, as well as the patient's expectations and needs.
Tendon debridement: A procedure that involves removing the damaged or inflamed parts of the tendon and repairing the remaining healthy tissue.
Tendon release: A procedure that involves cutting the tendon from the bone and reattaching it to a different part of the bone, to reduce the tension and stress on the tendon.
Tendon graft: A procedure that involves replacing the damaged tendon with a piece of tendon from another part of the body, such as the wrist or the foot.
There is no sure way to prevent lateral epicondylitis, but some steps that can be taken to reduce the risk or recurrence are:
Warming up and cooling down before and after any activity that involves the wrist and forearm, such as sports or work.
Using proper technique and equipment for the activity, such as a racket with the right grip size, weight, and string tension, or a tool with an ergonomic handle and design.
Taking breaks and changing positions frequently during the activity, to avoid overloading or straining the elbow tendons.
Doing exercises and stretches that can keep the forearm muscles and tendons strong and flexible, such as wrist curls, wrist extensions, and finger squeezes.
Applying ice or heat to the elbow after the activity, to prevent or reduce inflammation and pain.
