That's not an uncommon exclamation from someone just diagnosed with tennis elbow. Tennis elbow, or lateral epicondylitis is a common problem in weekend athletes, but it's also a problem in manual laborers. It is found not only in tennis players, but in baseball players, swimmers, carpenters, plumbers, meat cutters, or anyone who repeats an arm motion over and over. This repetitive motion causes inflammation of the muscles and tendons on the lateral side (outside) of the elbow which causes the tendons to become frayed.

Tennis elbow occurs equally in men and women, usually between 35 and 50 years of age. The most common cause is overuse of the forearm muscles, but it can also be caused by a direct blow to the outside of the elbow.

The main complaints of someone who has tennis elbow are elbow pain and weakness. The pain may spread above and below the elbow and patients also notice a decrease in the grip strength of their hand. During a physical examination, tenderness is found over the lateral epicondyle of the elbow. X-rays may show calcium deposits of the lateral epicondyle. This calcification, or laying down of bone spurs, is one of the body's reactions to chronic inflammation. It occurs in only about 20% of patients.

Approximately 95% of patients suffering from tennis elbow respond to conservative treatment Activities that cause the pain should be avoided. Rest, anti-inflammatory medication, and application of ice are the treatments to be tried first. Exercises to strengthen the muscles of the forearm should be part of one's rehabilitation. (Super 7) A compression band placed around the forearm may reduce tension and provide relief in some patients. If these treatments are not effective, cortisone injections can be used to decrease pain and inflammation so the patient can tolerate exercise.

If tennis elbow does not respond to nonoperative therapy within 9 to 12 months, surgery may be necessary to relieve pain and to allow the patient to return to work or sports. The surgery requires only a small incision, 7 to 10 days in a splint and postoperative therapy to increase muscle strength. Research in the surgical treatment of tennis elbow with the arthroscope promises to shorten postoperative rehabilitation time, allowing the patient to return to work and sports more quickly.

Prevention of tennis elbow is very important. Stretching and strengthening exercises are the best preventive measures. Changes in equipment such as a lighter racket or hammer, can also help.

David Higgins, M.D.
Chevy Chase, Maryland