Injuries can occur to the tendons that attach to the elbow.

Lateral Epicondylitis

Lateral epicondylitis (tennis elbow) is inflammation of the tendons that extend the hand backward and away from the palm.

• Pain develops in the outer aspect of the elbow and back side of the forearm.
• Ice, rest, analgesics, and exercises are usually effective.

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.

When the Elbow Hurts Tennis elbow and golfer's elbow cause pain in different areas of the elbow and forearm.

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.

Treatment

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

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.

• An activity involving repeated stressful bending of the wrist toward the palm is the usual cause.
• Rest, ice, and analgesics help relieve pain.
• When pain subsides, stretching and strengthening exercises are done to help prevent recurrence.

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.

Diagnosis

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.

Treatment

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.

Strengthening the Wrist Muscles
These exercises are for lateral epicondylitis (tennis elbow). Sit on a chair next to a table. Place the injured forearm on the table, palm down, with the elbow straightened and the wrist and hand hanging over the edge. Hold a light weight in the hand. Slowly raise and lower the hand by bending and straightening the wrist. Repeat 10 times (1 set). Each set should last about 90 to 120 seconds for rehabilitation and about 50 to 70 seconds for general strength and conditioning. Rest 1 minute, then do 2 more sets of 10. If the exercise causes pain, stop immediately and try again the next day. Do this exercise every other day. Increase the weight as the exercise becomes easier. With the palms down and the arms outstretched in front of the body, hold a piece of wood the diameter of a broomstick with a 1-pound (about ½-kilogram) weight attached to it by a rope. Wind the weight up by rotating the stick. Repeat 10 times. Stop if any pain is felt. Do this exercise every other day. Gradually increase the weight but not the number of repetitions.

Last full review/revision February 2009 by Paul L. Liebert, MD