Tennis elbow

and Carola Felchner, science journalist

Dr. med. Mira Seidel is a freelance writer for the medical team.

More about the experts

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Despite the name, the tennis elbow (medical epicondylitis humeri radialis, epicondylitis humeri lateralis) is not only found in tennis players. Rather, the term describes a painful change in certain tendons in the area of the elbow. The trigger is an overload caused by repetitive movements. Such movements are often made by tennis players, but also by other people.Read everything you need to know about the topic here: How do you recognize a tennis elbow? What can be done about the complaints? What are the chances of recovery?

Brief overview

What is a tennis elbow? Painful overload of certain tendons in the area of the elbow.
Symptoms: tenderness on the outside of the elbow, the joint can no longer be fully extended, weakness in the wrist
Causes: Recurring movements in the elbow joint, such as with frequent computer work (especially work with the mouse), musicians (such as violinists) or athletes (such as rowers or tennis players)
Diagnostics: doctor-patient consultation, various tests (movement and grip tests), x-rays, if necessary magnetic resonance imaging (magnetic resonance imaging, MRI) or ultrasound
Treatment: Resting, relieving the pressure, cooling and later possibly warming, if necessary special bandage as well as medication, stretching and strengthening exercises etc. In some cases surgery.
Responsible specialist: orthopedist
Prognosis: Long healing process, but good chance of full recovery.

Tennis elbow: treatment

There is no generally accepted uniform approach to tennis elbow treatment that has been scientifically proven to be the best therapy success. In any case, the first thing to do is to eliminate the cause of the overload: the elbow is immobilized and protected. Conservative measures such as cooling and possibly pain relievers alleviate the discomfort. It may be useful to wear a special bandage or an epicondylitis brace, a type of pressure bandage. Other possible therapeutic measures are, for example, ultrasound treatment as well as stretching and strengthening exercises. In severe cases, when conservative tennis elbow treatment does not help enough, surgery may be necessary.

Read more about the different ways you can treat tennis elbow below:

Treat tennis elbow with conservative measures

Relief: The aim of tennis elbow therapy is to restore the function of the muscle-tendon unit in the elbow area. First of all, it is important to eliminate the cause (overload). In the case of acute tennis elbow, the arm is first spared, relieved, raised and supported, for example, with a tennis elbow splint. At the same time, you should avoid overexertion and improper stress in everyday life, work and sport.

For the period after recovery, it is important to correct the movement patterns that presumably have triggered the tennis elbow: This can be achieved, for example, by adapting the workplace (ergonomic computer mouse) or technical training (e.g. striking technique in tennis). In addition, regular breaks can prevent renewed overload.

Stretching and strengthening: As part of the tennis elbow treatment at home, you can and should stretch and strengthen the arm muscles - but only if you no longer experience severe pain when performing the exercises. Targeted strength training in particular can be helpful in the early stages of the disease: According to experts, this reduces the blood flow in the relevant area, which reduces the pain.

There are also special tennis elbow stretching exercises: for example, stretch your elbow completely and turn your forearm inwards. Then carefully overstretch the aching hand so that the fingers are pointing outwards. You should hold the tension for 15 seconds, then take a short break and finally start all over again. You can repeat this training up to three times a day.

Discuss such exercises beforehand with your physical therapist or doctor and let them show you how to do them correctly.

Physical therapy: A tennis elbow can also be treated with physical therapy measures. For example, massages of the wrist muscles and heat or cold treatments are suitable. Whether you should cool or warm the tennis elbow better depends on the stage of the injury: In the acute stage and after intense exercise, the cold has a soothing effect (put towel-wrapped ice on for 20 to 30 minutes, pause for an hour, repeat). In contrast, with a tennis elbow in the chronic stage, heat is much more beneficial.

Bandages: In the case of severe symptoms, those affected can wear a tennis elbow bandage (epicondylitis brace) over the elbow and wrist for a few weeks. It is available in some sports shops or in medical supply stores. The epicondylitis brace uses a small cushion (pad) to exert pressure on the corresponding muscles and tendons of the forearm so that it is better stabilized and the insertion of the extensor tendon is relieved. The pad is activated when you close your fist. The epicondylitis brace restricts the mobility of the arm, which is useful in this case: “Forced rest” can accelerate the healing process.

The pad should be about two inches below the elbow joint. There should be a finger between the arm and the pillow.

Taping: Tape bandages and so-called kinesio tapes can also alleviate the symptoms of tennis elbow. To properly tape the tennis elbow, you can look at the corresponding instructions on the Internet. However, taping can be done more easily and professionally by your physiotherapist.

Medication: Doctors often use anti-inflammatory medication to treat tennis elbow (either applied locally, for example in the form of gel, or by mouth). In addition to the classic rheumatic drugs (anti-inflammatory drugs), there are also various pain relievers, drugs for muscle relaxation, herbal preparations, enzymes and nucleotides. You should discuss with your doctor which preparations are useful in individual cases.

Ultrasound & Co .: A treatment with ultrasound can also be an effective means for a tennis elbow. It is used either to deliver pain-relieving agents under the skin (sonophoresis) or to generate local heat. This improves the local blood circulation, loosens the muscles and can thus promote the healing process.

Transcutaneous electrical nerve stimulation (TENS): TENS is a gentle form of electrotherapy and is also called electrical stimulation therapy. Light electrical impulses are delivered to pain-conducting nerve fibers. This can inhibit the transmission of pain stimuli and thus alleviate the symptoms.

Infiltration therapy: Some doctors inject patients with tennis elbow with a local anesthetic to interrupt the nerve conduction in the affected area and thus relieve the pain. Anti-inflammatory cortisone can also be injected. It is also possible to inject the neurotoxin botulinum toxin ("Botox") at the main pain point and into the affected muscles. This is "paralyzed" for a few months and can thus recover.

Further treatment options are, for example, extracorporeal shock wave therapy (pain relief through externally generated pressure waves), X-ray stimulation (for anti-inflammatory and pain relief) and laser treatment. Their effectiveness in a tennis elbow has only been proven by a few studies.

Operate tennis elbow

In principle, tennis elbow treatment can also be performed surgically. The surgeon cuts the tendon origin of the extensor muscles to relieve the tissue. In addition, two millimeters of the top of the bony protrusion of the humerus is sometimes cut off.

In most cases, this type of procedure gives good results. However, it is only advisable in severe cases of tennis elbow if conservative treatment has not been successful for several months. For example, an operation can be indicated in the case of persistent and very severe pain that restricts everyday life. An operation may also be necessary for patients who have accompanying injuries in addition to their tennis elbow.

Tennis elbow & homeopathy

Some patients with tennis elbow treat their symptoms with homeopathic remedies, in addition to conventional medical measures. For example, against acute inflammation and pain Arnica help. Often, the pain subsides with slight movement Rhus toxicodendron recommended. If, on the other hand, every movement is painful, it should Bryonia be better suited. Also applies Ruta as a proven remedy for tendon and periosteum injuries.

Tennis elbow - avoid too long breaks!

Three questions for

Prof. Dr. habil. Peter Diehl,
Specialist in orthopedics and trauma surgery
1
Can I prevent a tennis elbow?

Prof. Dr. habil. Peter Diehl
There are different possibilities. You should avoid repetitive motion sequences. If that doesn't work, just use your left hand if you are right-handed or vice versa. When exercising, it's not just important that you do warm-up and stretching exercises. In sports such as tennis or golf, the right technique helps prevent overloading the affected arm.
2
How long does it take for the affected arm to be fit again?

Prof. Dr. habil. Peter Diehl
Patients need patience because they often have to deal with prolonged restrictions on movement and exercise. The chances of recovery are nevertheless good. But that takes some discipline. Those affected should carry out the treatment consistently and do stretching exercises at home or, as soon as they no longer have acute pain, strengthen the extensor and flexor muscles of the wrist.
3
What else do you advise tennis elbow patients?

Prof. Dr. habil. Peter Diehl
Acute complaints require the arm to rest. However, it should not be out for too long, as otherwise muscles, tendons and ligaments in the area of the elbow can shorten. In everyday life, aids such as ergonomic computer keyboards or PC mice provide relief. And: the earlier you go to the doctor and start the right therapy, the greater the chances of success!
Prof. Dr. habil. Peter Diehl,
Specialist in orthopedics and trauma surgery
Chief physician of minimally invasive shoulder and knee joint surgery at the Orthopedic Center Munich East, expert in cartilage and stem cell therapy

Tennis elbow: symptoms

Typical symptoms of tennis elbow are tenderness on the outside of the elbow. They are noticeable at the tendon attachment of the hand and finger extensor muscles.

In addition, those affected can usually no longer fully straighten the elbow joint.

Another symptom of tennis elbow can be a feeling of weakness in the wrist. Forceful gripping, a strong fist, a strong grip when shaking hands or even just holding a cup is then often no longer possible.

Here is a summary of typical tennis elbow symptoms:

Relieving posture - the elbow can no longer be straightened
Tension pain on the outside of the elbow
Pain on the move
Wrist weakness
no strength to close a fist
Tingling in the hand

Tennis elbow: causes and risk factors

A tennis elbow is caused by overloading the outside of the elbow. Stressful, repetitive movements or a sudden increase in stress without adequately prepared muscles result in microscopic tears in the tissue. Tendons and fiber cartilage are most susceptible to such minor injuries (microtraumas). The resulting pain may radiate into the upper or lower arm.

Basically, a tennis elbow can be favored by the following risk factors:

One-sided stress: Overloading during sport as well as monotonous sequences of movements with little stress in everyday life and at work can be the cause of a tennis elbow. For example, people who work a lot on the computer (especially work with the mouse), certain craftsmen (frequent hammering!), Musicians (such as violinists), domestic workers (a lot of ironing!) And athletes (such as rowers or tennis players) easily develop a tennis elbow .

Weak forearm muscles and old age (decreasing tendon elasticity!) Also favor micro-injuries in the elbow area and thus a tennis elbow.

(Previous) illnesses and treatments: Sometimes previous illnesses can also be the cause of a tennis elbow. This could be a previous accident or a joint disease. Previous conservative or surgical treatment in the elbow area can also increase the risk of tennis elbow.

This is how the tennis elbow is created

Overloading the tendon attachment at the elbow causes micro-injuries. They lead to a painful inflammation.

Tennis elbow most commonly occurs in people in their fourth decade of life.

Golfer arm

As with tennis elbow, overloading due to recurring movement patterns is the trigger for discomfort in the arm area. While the outside of the elbow is affected in tennis elbows, complaints on the inside of the elbow occur in the much rarer golfer's arm (epicondylitis humeri ulnaris).

Just like the tennis elbow, the golfer's arm not only affects a certain group of athletes (golfers), but also, for example, gymnasts, throwing athletes and strength athletes doing free weight training if they want to compensate for this lack of technique with strength.

The treatment of the golfer's arm is similar to that of the tennis elbow. The prognosis is also comparable: the symptoms often go away on their own. If not, the chances of a complete cure are good with the correct treatment as early as possible. However, the healing process can take a while.

You can find out more about how to recognize a golfer's arm and what you and your doctor can do against the pain in the article Golfer Arm.

Tennis elbow: examinations and diagnosis

If you suspect a tennis elbow, you should see your family doctor. Some patients also go straight to an orthopedic specialist. The doctor will talk to you in detail first to take down your medical history. This is followed by a physical exam with various tests. He may also do imaging tests (such as X-rays) to rule out other causes of the pain.

anamnese

In the anamnesis interview, the doctor asks about the exact complaints, possible injuries or previous illnesses as well as possible triggers of the symptoms. This information helps the doctor to narrow down the cause of the symptoms. Possible questions from the doctor include, for example:

Did you injure your arm, such as a fall?
Have you ever had problems with your arm for no apparent reason?
Where exactly do you feel pain?
Is it a movement or rest pain?
Are hand activities, such as strong gripping, painful?
Does the arm or hand feel powerless because of the pain?
What do you work What sport do you do?

Physical exam and tests

After the consultation with the patient, the doctor will examine your arm. Even at first glance, a protective posture of the arm can be noticed: Many patients with tennis elbow instinctively keep the elbow still and avoid completely straightening the forearm. For a more detailed clarification, the doctor feels the elbow and checks whether certain areas are sensitive to pressure.

So-called provocation tests are also important for the diagnosis: For example, the doctor asks you to stretch your hand in the wrist against resistance (i.e. move the back of the hand towards the forearm). With a tennis elbow, this causes pain because the hand extensor on the side of the spoke (extensor carpi radialis brevis muscle) is usually affected. In tennis elbow, the superficial extensor of the forearm (extensor digitorum communis muscle) is also often painful: In this case, it hurts when the middle finger is to be stretched against resistance.

The so-called “coffee cup test” is also characteristic of a tennis elbow. And that is to be taken literally: the doctor will have you lift a full cup with the hand of the arm in question. If this is causing you pain, it suggests tennis elbow. The chair test is also informative: You have to lift a chair by the back of the chair with one hand with your arm outstretched and your forearm turned inward. This is very painful with a tennis elbow.

To rule out other possible causes of the symptoms, the doctor will also examine your cervical spine, shoulder, and hand, and assess blood flow, motor skills, and sensitivity (including signs of nerve congestion) in the arm in question.

Imaging examinations

An X-ray can help the doctor rule out some other possible causes of the pain in the elbow joint, such as osteoarthritis. If you have tennis elbow, the x-ray is usually normal. In some patients, calcification of the tendon insertion can be seen - but this does not affect the course of the disease.

Magnetic resonance imaging (MRI) or an ultrasound scan can also be done. This is mainly done with unclear elbow injuries. The doctor can use these examination methods to rule out a tumor, for example. In the case of chronic complaints, the MRI shows the degree of wear and tear on the tendon.This in turn gives indications of the expected course of the disease.

Tennis elbow: course and prognosis

The prognosis for tennis elbow is good. However, treatment can be lengthy. Those affected have to be prepared for several months with painful movement and exercise impairments.

In around 80 out of 100 people affected, the symptoms disappear completely within a year. In many cases, conservative treatment, for example with medication, physiotherapy and infiltration therapy, is sufficient. An operation is only necessary if other therapeutic approaches are ineffective and / or the patient has severe symptoms over a long period of time.

In general, the following applies to tennis elbow: the earlier therapy is started, the greater the chances of success. The therapy should also be carried out consistently, otherwise the pain can become more severe and even chronic.

Prevent tennis elbow

For example, if you are prone to a tennis elbow due to your job or a (sporting or musical) hobby, there are a few things you can do to prevent (renewed) overloading. For example, strengthen the muscles of the arms through regular exercise, take a break from monotonous exercise and see a doctor at the first signs of tennis elbow.

Tags: Diagnosis fitness medicinal herbal home remedies