Lateral Epicondylitis (Tennis Elbow)

with Rehab

ExitCare ImageLateral epicondylitis involves inflammation and pain around the outer portion of the elbow. The pain is caused by inflammation of the tendons in the forearm that bring back (extend) the wrist. Lateral epicondylittis is also called tennis elbow, because it is very common in tennis players. However, it may occur in any individual who extends the wrist repetitively. If lateral epicondylitis is left untreated, it may become a chronic problem.

SYMPTOMS

  • Pain, tenderness, and inflammation on the outer (lateral) side of the elbow.

  • Pain or weakness with gripping activities.

  • Pain that increases with wrist twisting motions (playing tennis, using a screwdriver, opening a door or a jar).

  • Pain with lifting objects, including a coffee cup.

CAUSES

Lateral epicondylitis is caused by inflammation of the tendons that extend the wrist. Causes of injury may include:

  • Repetitive stress and strain on the muscles and tendons that extend the wrist.

  • Sudden change in activity level or intensity.

  • Incorrect grip in racquet sports.

  • Incorrect grip size of racquet (often too large).

  • Incorrect hitting position or technique (usually backhand, leading with the elbow).

  • Using a racket that is too heavy.

RISK INCREASES WITH:

  • Sports or occupations that require repetitive and/or strenuous forearm and wrist movements (tennis, squash, racquetball, carpentry).

  • Poor wrist and forearm strength and flexibility.

  • Failure to warm up properly before activity.

  • Resuming activity before healing, rehabilitation, and conditioning are complete.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear and use properly fitted equipment.

  • Learn and use proper technique and have a coach correct improper technique.

  • Wear a tennis elbow (counterforce) brace.

PROGNOSIS

The course of this condition depends on the degree of the injury. If treated properly, acute cases (symptoms lasting less than 4 weeks) are often resolved in 2 to 6 weeks. Chronic (longer lasting cases) often resolve in 3 to 6 months, but may require physical therapy.

RELATED COMPLICATIONS

  • Frequently recurring symptoms, resulting in a chronic problem. Properly treating the problem the first time decreases frequency of recurrence.

  • Chronic inflammation, scarring tendon degeneration, and partial tendon tear, requiring surgery.

  • Delayed healing or resolution of symptoms.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. Strengthening and stretching exercises may help reduce discomfort, if performed regularly. These exercises may be performed at home, if the condition is an acute injury. Chronic cases may require a referral to a physical therapist for evaluation and treatment. Your caregiver may advise a corticosteroid injection, to help reduce inflammation. Rarely, surgery is needed.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be recommended. These injections should be reserved only for the most severe cases, because they can only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

Symptoms get worse or do not improve in 2 weeks, despite treatment.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Epicondylitis, Lateral (Tennis Elbow)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION – Wrist Flexion, Active-Assisted

  • Extend your right / left elbow with your fingers pointing down.*

  • Gently pull the back of your hand towards you, until you feel a gentle stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.

ExitCare Image RANGE OF MOTION – Wrist Extension, Active-Assisted

  • Extend your right / left elbow and turn your palm upwards.*

  • Gently pull your palm and fingertips back, so your wrist extends and your fingers point more toward the ground.

  • You should feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.

ExitCare Image STRETCH - Wrist Flexion

  • Place the back of your right / left hand on a tabletop, leaving your elbow slightly bent. Your fingers should point away from your body.

  • Gently press the back of your hand down onto the table by straightening your elbow. You should feel a stretch on the top of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Wrist Extension

  • Place your right / left fingertips on a tabletop, leaving your elbow slightly bent. Your fingers should point backwards.

  • Gently press your fingers and palm down onto the table by straightening your elbow. You should feel a stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Epicondylitis, Lateral (Tennis Elbow)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

ExitCare Image STRENGTH – Wrist Flexors

  • Sit with your right / left forearm palm-up and fully supported on a table or countertop. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight, or a piece of rubber exercise band or tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Wrist Extensors

  • Sit with your right / left forearm palm-down and fully supported on a table or countertop. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight, or a piece of rubber exercise band or tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ulnar Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit while holding a rubber exercise band or tubing, with your healthy arm supported on a table or countertop.

  • Move your wrist, so that your pinkie travels toward your forearm and your thumb moves away from your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day

ExitCare Image STRENGTH - Radial Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit while holding a rubber exercise band or tubing, with your injured arm supported on a table or countertop.

  • Raise your hand upward in front of you or pull up on the rubber tubing.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Supinators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm down.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Grip

  • Grasp a tennis ball, a dense sponge, or a large, rolled sock in your hand.

  • Squeeze as hard as you can, without increasing any pain.

  • Hold this position for __________ seconds. Release your grip slowly.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Elbow Extensors, Isometric

  • Stand or sit upright, on a firm surface. Place your right / left arm so that your palm faces your stomach, and it is at the height of your waist.

  • Place your opposite hand on the underside of your forearm. Gently push up as your right / left arm resists. Push as hard as you can with both arms, without causing any pain or movement at your right / left elbow. Hold this stationary position for __________ seconds.

Gradually release the tension in both arms. Allow your muscles to relax completely before repeating.