Injuries can occur to the tendons that attach to the elbow.
Lateral epicondylitis (tennis elbow) is inflammation of the tendons that extend the hand backward and away from the palm.
The forearm muscles that are attached to the outer part of the elbow can become sore when stressed repetitively. Lateral epicondylitis can be caused by repetitive backhand returns in tennis. Other activities (for example, rowing and doing forearm curls while holding weights and repeatedly and forcefully turning a screwdriver) can also cause lateral epicondylitis.
Factors that increase the chance of developing lateral epicondylitis among tennis players include having weak shoulder and forearm muscles, playing with a racket that is too tightly strung or too short, hitting the ball off center on the racket (out of the sweet spot), and hitting heavy, wet balls. Hitting backhanded and allowing the wrist to bend increase the chance of developing lateral epicondylitis.
Symptoms and Diagnosis
Pain occurs in the outside of the forearm when the wrist is extended away from the palm. Pain can extend from around the elbow to the middle of the forearm. Continuing to stress the forearm muscles can worsen symptoms and result in pain, even at rest.
Doctors make the diagnosis based on the symptoms and results of a physical examination. The outer elbow hurts when the person places the arm and hand palm down on a table and tries to raise the hand against resistance by bending the wrist backward.
Ice is applied to the outer elbow, and exercises that cause pain are avoided. Exercises that do not use the wrist extensor muscles primarily, such as jogging or cycling, can be substituted to maintain physical fitness. As pain decreases, elbow and wrist flexibility and strengthening exercises can be started. Use of a tennis elbow brace (usually for a few weeks) can be beneficial. When pain from lateral epicondylitis is severe, a health care practitioner may inject a corticosteroid into the outer elbow. Surgery is rarely needed.
Medial epicondylitis (golfer's elbow) is inflammation of the tendons that flex or bend the wrist toward the palm, causing pain on the inner aspect of the elbow and forearm.
This injury is caused by bending the wrist against resistance toward the palm repetitively. Actions that produce such force include serving with great force in tennis; using an overhand and a top spin serve; hitting heavy, wet balls; using a racket that is too heavy or that has a grip that is too small or has strings that are too tight; pitching a baseball; and throwing a javelin. Poor technique when hitting the ball in golf can cause this inflammation as well—hence the term golfer's elbow. Injury occurs when “hitting from the top” and is basically forcefully bringing the club with the right arm (right-handed golfer) down from the top of the swing, placing extreme stress on the flexor muscles of the right elbow instead of pulling down the club with the left arm and the body. Nonathletic activities that may cause medial epicondylitis include bricklaying, hammering, and typing.
Pain is felt on the inner aspect of the elbow and forearm. It is worse when the wrist moves toward the palm.
Doctors make the diagnosis based on the symptoms and results of an examination. The doctor asks the person to sit in a chair with the injured arm resting on a table, palm up. The doctor holds the wrist down and asks the person to raise the hand by bending the wrist. A person who has medial epicondylitis feels pain at the inner aspect of the elbow.
Initial treatment includes avoiding any activity that causes pain when the wrist is bent toward the palm. Ice applied over the painful area and nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve pain. After pain has decreased, an exercise program that strengthens the wrist and shoulder muscles is begun. Surgery is rarely needed.
Last full review/revision February 2009 by Paul L. Liebert, MD