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Dr. Maria Michailidou




Tennis Elbow Overview

Tennis elbow is a condition caused by inflammation of the tendons on the outer bony prominence (lateral epicondyle) of the elbow. Certain repetitive movements of the wrist can cause this condition. Tennis elbow can occur in anyone who strains the tendons of the forearm and is not limited to tennis players.

Tennis Elbow Causes

  1. One-handed backhand with poor form
  2. A late forehand swing resulting in bending the wrist significantly
  3. Snapping and turning the wrist while serving with full power

Tennis Elbow Symptoms and Signs

Tenderness on the outer bony part of the elbow

Morning stiffness of the elbow with persistent aching

Soreness in the forearm

Pain worse when grasping or holding an object

Tennis elbow does not usually lead to serious problems. If the condition continues and is left untreated, however, loss of motion or loss of function of the elbow and forearm can develop.

Call your doctor if the following conditions develop:

Pain that limits your daily activity

Pain that lasts despite ice, resting, and over-the-counter anti-inflammatory pain relievers

Any weakness or numbness in the hand, which may mean you have another type of injury in the wrist or elbow


To diagnose tennis elbow, the physician performs a battery of tests in which he places pressure on the affected area while asking the patient to move the elbow, wrist, and fingers. X-rays can confirm and distinguish possibilities of existing causes of pain that are unrelated to tennis elbow, such as fracture or arthritis. Medical ultrasonography and magnetic resonance imaging (MRI) are other valuable tools for diagnosis but are frequently avoided due to the high cost.[1] MRI screening can confirm excess fluid and swelling in the affected region in the elbow, such as the connecting point between the forearm bone and the extensor carpi radialis brevis.

Diagnosis is made by clinical signs and symptoms that are discrete and characteristic. With the elbow fully extended, the patient feels points of tenderness over the affected point on the elbow—which is the origin of the extensor carpi radialis brevis muscle from the lateral epicondyle (extensor carpi radialis brevis origin). There is also pain with passive wrist flexion and resistive wrist extension (Cozen's test).

Depending uponseverity and quantity of multiple tendon injuries that have built up, the extensor carpi radialis brevis may not be fully healed by conservative treatment. Nirschl defines four stages of lateral epicondylitis, showing the introduction of permanent damage beginning at Stage 2.

1. Inflammatory changes that are reversible

2. Nonreversible pathologic changes to origin of the extensor carpi radialis brevis muscle

3. Rupture of ECRB muscle origin

4. Secondary changes such as fibrosis or calcification.