Advice from a Certified Hand Therapist: What is Tennis Elbow?

Advice from a Certified Hand Therapist: What is Tennis Elbow?
Tennis elbow, also referred to as lateral epicondylitis or lateral elbow tendinopathy, is a common condition of the upper extremity typically caused by repetitive motions of the arm and wrist. Pain from this condition can be long lasting, causing limitations during work, leisure, and daily tasks. Below are some commonly addressed questions regarding tennis elbow or lateral elbow tendinopathy to help you better understand this condition.
Q: What is lateral epicondylitis/tennis elbow?
A: Tendionpathy or tendinitis occurs with irritation or inflammation to the tendon of a muscle or group of muscles. Lateral epicondylitis is specifically referring to irritation of the tendons of the muscles that extend your wrist and fingers. This muscle group attaches to the lateral epicondyle of your elbow.  The irritation associated with this condition causes localized pain on the outside of the elbow.
Q: What is the lateral epicondyle?
A: The lateral epicondyle is a bony prominence on the lower end of humerus, or bone of the upper arm. It is found on the ‘outside’ (or lateral) aspect of the elbow and is the site of attachment for several muscles found in the forearm. Due to this attachment of tendons, the area is susceptible to injury.
Q: I don’t play tennis so, why do I have ‘tennis elbow’?
A: The term ‘tennis elbow’ refers to one mechanism of injury to this area, which is playing tennis. However, pain at the lateral elbow can be caused by numerous actions, motions, or activities that do not involve tennis. In addition, starting new activities that your body isn't conditioned for can increase the likelihood of  developing this condition. For example, raking leaves in the fall, painting your bedroom a new color, or starting a new job, such as being a gardener, mechanic, electrician or plumber.
Q: What are the symptoms of tennis elbow?
A: People who develop this condition will report pain at the outer aspect of the involved elbow, pain with gripping and lifting items (even lightweight items), and oftentimes pain that radiates into the forearm. In addition, those suffering from this condition will typically have pain when the bony prominence of the lateral epicondyle is touched and will report functional limitations with use of the injured arm. It may be reported that sufferers cannot do simple tasks without pain such as brushing their teeth, squeezing or gripping lightly with the affected hand, and/or engaging in leisure or sport activities secondary to pain. In more severe cases, pain may occur with motion of the elbow to the point where they may even lose full movement of the elbow.
Q: Who is at greatest risk for developing tennis elbow?
A: Individuals who engage in repetitive motions of the wrist, hand and arm on a regular basis, such as through an occupation, sport activity or ADL’s such as raking leaves and gardening are at a higher risk for developing tennis elbow. Additionally, according to Rehabilitation of the Hand and Upper Extremity, those between the ages of 35-55, those suffering direct blows or injuries to the elbow, and/or those using inappropriate or poorly fitting sports equipment are at greater risk.
Q: How do I prevent tennis elbow?
A: Using proper warm ups and stretching techniques when engaging in sport or work tasks that require repetitive actions of the hand, wrist and arm are some of the ways you can help prevent tennis elbow. Treating traumas to the elbow with ice, rest and if needed, following up with a physician are also important. Ensuring equipment used in sport activities are fitted properly for you as well as using effective techniques in use of the equipment are additional methods of prevention. Also, avoiding repetitive tasks, if able, is another effective way to reduce risk. If avoiding repetitive motions or activities is not an option, taking breaks to rest muscles is also helpful to avoid the development of tendinopathy. 
Q: How is tennis elbow treated?
A: Tennis elbow can often be treated conservatively by a certified hand therapist. Treatment techniques may include education on activity modification, safety education with use of equipment, discussion on techniques to address pain and inflammation, and possible use of orthoses to rest muscles. A hand therapist may choose to have those suffering from tennis elbow wear a wrist brace to put the injured muscle and/or tendon on slack. Another option is a counterforce brace that decreases the load on the injured tendon. Additional treatment techniques of soft tissue mobilization, proper strengthening exercises, stretching, and modalities may be used to help address pain associated with tennis elbow. Following up with a hand surgeon may also be beneficial if symptoms are not resolving.
Symptoms of tennis elbow can lead to debilitating pain that limit engagement in work, leisure, and sport activity. Fortunately, this common overuse injury of the upper extremity is regularly treated by certified hand therapists or hand surgeons. For additional information, please reach out to your local hand therapist.

Steph Clement Pogonowski, MS, OTR/L, CHT is a Certified Hand Therapist and a member of the American Society of Hand Therapists.
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