Lateral epicondylitis is inflammation of the tendons of muscles that extend the hand backward and away from the palm.
(See also Overview of Sports Injuries.)
Pain develops in the outer part of the elbow and back side of the forearm.
Ice, rest, analgesics, exercises, and sometimes a tennis elbow brace are usually effective.
The forearm muscles that are attached to the outer part of the elbow can become sore when stressed repetitively (see figure When the Elbow Hurts). The tendon that attaches these muscles to the elbow can become inflamed and very sore.
Causes of Lateral Epicondylitis
Lateral epicondylitis can be caused by repetitive backhand returns in tennis. Other activities (for example, rowing and doing forearm curls while holding weights or 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 of Lateral Epicondylitis
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. Pain may be increased by firm gripping (handshaking) or even turning door knobs. Continuing to stress the forearm muscles can worsen this condition and result in pain even when the forearm is not being used.
Diagnosis of Lateral Epicondylitis
A doctor's evaluation
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 of Lateral Epicondylitis
Rest
Ice
Rehabilitation
Sometimes steroid injections
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 due to lateral epicondylitis is severe, a doctor may inject a steroid (sometimes also known as a glucocorticoid or corticosteroid) into the outer elbow. Surgery is rarely needed.
1. Position involved hand palm up.
2. Grasp fingers on involved hand with the other hand.
3. Keep elbow straight on inv
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Place forearm on table with the hand palm up, off the edge of the table.
2. Curl wrist up into flexion.
3. Slowly lo
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Grasp and gently squeeze towel roll with both hands.
2. Twist towel in alternating directions.
3. Do 3 sets of 10 r
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Flatten putty on table.
2. Curl (flex) fingers and place on putty.
3. Straighten and spread fingers, pushing into pu
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Position involved hand palm up.
2. Grasp fingers on involved hand with the other hand.
3. Keep elbow straight on involved arm.
4. Pull hand and fingers gently into extension.
5. Hold stretch for 30 seconds.
6. Do 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Place forearm on table with the hand palm up, off the edge of the table.
2. Curl wrist up into flexion.
3. Slowly lower and extend wrist to starting position.
4. Do 3 sets of 10 repetitions, 1 time a day.
5. Special instructions
a. Focus on lowering (eccentric) phase with a count of 4 to extend wrist down to starting position and a count of 2 up for wrist flexion.
b. Start with light weight (for example, a soup can) or no weight.
c. Can also do exercise with band resistance.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Grasp and gently squeeze towel roll with both hands.
2. Twist towel in alternating directions.
3. Do 3 sets of 10 repetitions, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Flatten putty on table.
2. Curl (flex) fingers and place on putty.
3. Straighten and spread fingers, pushing into putty.
4. Do 3 sets of 10 repetitions, 1 time a day.
5. Special instructions
a. Start with lowest resistance putty (that is, yellow).
b. Can also do exercise using rubber band around fingers for resistance.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
