Understanding Tennis Elbow (Lateral Epicondylitis)
Tennis elbow occurs when the tendons in the elbow are overloaded, usually by repetitive motions of the wrist and arm. Anyone can develop tennis elbow, especially in their dominant arm due to repetitive activities such as playing tennis or using tools. The dominant arm is more commonly affected because it is used more frequently in repetitive movement.
Common symptoms include pain and tenderness on the outside of the elbow, weakness in the forearm, and difficulty with gripping objects [1]. Repetitive movement of the wrist and arm is a key contributor to the development of these symptoms.
Risk factors for developing tennis elbow include age, activity level, and lifestyle habits such as smoking and obesity.
Causes of Tennis Elbow
- Repetitive wrist and arm motions
- Overuse of the forearm muscles
- Improper technique in sports or activities
- Direct trauma to the elbow
- Age-related wear and tear
Tennis elbow is an overuse injury primarily caused by repetitive wrist motions and gripping, which lead to tiny tears in the common extensor tendon at the lateral epicondyle. The extensor carpi radialis brevis (ECRB) tendon, also known as carpi radialis brevis, is most commonly affected, and degenerative changes in the ECRB tendon are central to the development of elbow tendinopathy. Pain is typically felt at the lateral elbow, and activities involving wrist extensors, radial deviation, and forearm supination can exacerbate symptoms.
Identifying the underlying cause is essential for effective treatment and prevention of recurrence [2].
Symptoms of Tennis Elbow
- Pain and tenderness on the outside of the elbow
- Weakness in the forearm
- Difficulty with gripping or lifting objects
- Stiffness in the elbow joint
- Pain that worsens with activity
These are typical tennis elbow symptoms resulting from tendon overload.
Symptoms can vary in intensity and may worsen with certain activities or prolonged use of the arm. Some individuals may experience severe pain that interferes with daily activities or is triggered by minimal movements.
Continuing to use an injured elbow without proper healing can lead to further complications, such as tendon rupture or tearing.
Differential Diagnosis
When evaluating elbow pain, it’s essential to consider a range of possible conditions beyond lateral epicondylitis, or tennis elbow. Accurate diagnosis is key, as several issues can mimic the symptoms of tennis elbow. For example, medial epicondylitis—often called golfer’s elbow—affects the inner side of the elbow, while lateral epicondylitis impacts the outer, or lateral, aspect. Radial tunnel syndrome, which involves compression of the radial nerve, can also cause discomfort in the elbow and forearm, sometimes making it difficult to distinguish from tennis elbow.
Other potential causes of elbow pain include elbow bursitis, osteochondritis dissecans, and triceps tendinitis. A thorough physical examination and detailed medical history are crucial to diagnose tennis elbow correctly and to rule out these other conditions. In some cases, imaging studies such as X-rays or MRI scans may be needed to confirm the diagnosis and exclude other sources of pain in the elbow joint.
Lifestyle factors, such as playing tennis or participating in other racquet sports, can increase the risk of developing tennis elbow, but similar symptoms can arise from a variety of repetitive activities. By carefully considering all possible causes and performing a comprehensive assessment, healthcare professionals can accurately diagnose tennis elbow and ensure the most effective treatment plan is chosen.
Diagnosis
Diagnosing tennis elbow involves a comprehensive evaluation, including:
- Medical history and physical exam, including resisted wrist extension to provoke symptoms
- Assessment of pain and range of motion
- Imaging studies (e.g., X-rays, MRI) to rule out other conditions
Accurate diagnosis is essential for developing an effective treatment plan [3]. A physical exam often includes resisted wrist extension, which can help confirm the diagnosis by reproducing pain at the lateral epicondyle.
Treatments for Tennis Elbow
Effective management of tennis elbow involves a combination of treatments tailored to the individual’s needs, highlighting the importance of treating lateral epicondylitis with a tailored approach. Options include:
- Physical therapy: Exercises to strengthen the forearm muscles and improve flexibility.
- Pain management: NSAIDs, corticosteroid injections, or topical analgesics.
- Manual therapy: Techniques such as massage or manipulation to reduce tension and improve mobility.
- Lifestyle modifications: Ergonomic adjustments and activity modification to reduce strain on the elbow.
- Surgical intervention: In severe cases, surgery may be necessary to fix tennis elbow and repair damaged tissues when conservative treatments fail.
Pain relief is a primary goal when treating lateral epicondylitis. For persistent cases, options such as corticosteroid injection and autologous whole blood injections may be considered to reduce pain and promote tendon healing.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat tennis elbow.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with tennis elbow.
As prolotherapy is helping to treat the root cause of tennis elbow, it is deemed to be a permanent fix, preventing the symptoms from returning.
Complications
If lateral epicondylitis is not addressed promptly, complications can develop that may significantly impact daily life. One of the most common issues is chronic tennis elbow, where pain and weakness in the forearm muscles persist for months or even years, making it difficult to perform everyday tasks or play sports. In cases where conservative treatments such as physical therapy, pain relievers, and activity modification fail to relieve pain, surgical treatment—including tennis elbow surgery—may become necessary to repair the damaged tissue.
Other potential complications include nerve disease, which can cause numbness, tingling, or weakness in the arm or hand, and further degeneration of the injured tendon, leading to decreased strength and flexibility in the lower arm. Advanced therapies, such as extracorporeal shock wave therapy and platelet rich plasma injections, may be recommended to promote healing, increase blood flow, and reduce pain when standard treatments are not effective.
To minimize the risk of these complications, it’s important to seek medical attention if symptoms of tennis elbow persist or worsen. Early intervention with conservative treatments, including rest, cold packs, and physical therapy, can help relieve pain and support the healing process. By following a comprehensive treatment plan and addressing symptoms early, individuals can reduce the likelihood of chronic issues and restore full function to the elbow.
Case Study: Prolotherapy for Tennis Elbow
Patient: Mark, 45, experienced chronic elbow pain due to repetitive work activities.
Treatment: After limited relief from physical therapy and medications, Mark received a series of prolotherapy injections at ProHealth Clinic.
Outcome: Within three months, Mark reported a 75% reduction in pain and improved arm function, allowing him to return to work comfortably. His results were maintained at 12-month follow-up.
Frequently Asked Questions
What is the best treatment for tennis elbow?
A combination of physical therapy, lifestyle modifications, and prolotherapy is often recommended for tennis elbow. In severe cases, surgical intervention may be necessary.
Can tennis elbow be cured?
While some cases of tennis elbow can be resolved with treatment, others may require ongoing management. A combination of therapies can significantly improve symptoms and prevent recurrence.
How effective is prolotherapy for tennis elbow?
Clinical studies and patient experiences suggest prolotherapy can significantly reduce pain and improve function in tennis elbow, especially when other treatments have failed. It works by stimulating the body’s natural healing response and repairing damaged tissues [4].
How can I prevent tennis elbow from recurring?
Maintain good posture, use ergonomic tools, strengthen forearm muscles, and avoid repetitive strain. Early intervention and regular exercise can help prevent recurrence.
Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call
Don’t let tennis elbow control your life any longer. Join the thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.
Get in Touch
Phone: +441234380345
Email: info@prohealthclinic.co.uk
Our Clinic Locations
London: 104 Harley Street, Marylebone, W1G 7JD
Manchester: The Hadley Clinic, 64 Bridge Street, M3 3BN
Bedford: The Village Medical Centre, Kingswood Way, MK40 4GH
All clinics offer the same award-winning prolotherapy treatment with convenient appointment times, including evenings and weekends.
References
- Nirschl RP, et al. “Elbow tendinosis/tennis elbow.” Clin Sports Med. 1992;11(4):851-870. ScienceDirect
- Bisset L, et al. “A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia.” Br J Sports Med. 2005;39(7):411-422. BJSM
- Hauser RA, et al. “A systematic review of prolotherapy for chronic musculoskeletal pain.” Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159. SAGE Journals
- Rabago D, et al. “Prolotherapy in primary care practice.” Prim Care. 2010;37(1):65-80. PMC