Signs and symptoms
Pain on the outer part of the elbow (lateral epicondyle)
Point tenderness over the lateral epicondyle—a prominent part of the bone on the outside of the elbow
Pain with resisted wrist extension or passive wrist flexionSymptoms associated with tennis elbow include, but are not limited to, pain from the outside of the elbow to the forearm and wrist and pain during extension of wrist. Terminology
The term "tennis elbow" is widely used (although informal), but the condition should be understood as not limited to tennis players. Historically, the medical term "lateral epicondylitis" was most commonly used for the condition, but "itis" implies inflammation and the condition is not inflammatory.Since histological findings reveal noninflammatory tissue, the terms “lateral elbow tendinopathy" and "tendinosis” are suggested. In 2019, a group of international experts suggested that "lateral elbow tendinopathy" was the most appropriate terminology. But a disease of an attachment point (or enthesia) is most accurately referred to as an "enthesopathy." Causes
Enthesopathy of the extensor carpi radialis brevis origin is idiopathic, meaning that it has no known cause.Tennis players generally believe tennis elbow is caused by the repetitive nature of hitting thousands of tennis balls, which leads to tiny tears in the forearm tendon attachment at the elbow. Traditionally, people have speculated that tennis elbow is a type of repetitive strain injury resulting from tendon overuse and failed healing of the tendon, but there is no evidence of injury or repair on histopathology, and misinterpretation of painful activities as a source of damage is common.
Physical therapy
There are several recommendations regarding prevention, treatment, and avoidance of recurrence that are largely speculative including stretches and progressive strengthening exercises to prevent re-irritation of the tendon and other exercise measures.One way to help treat minor cases of tennis elbow is simply to relax the affected arm. The rest lets stress and tightness within the forearm slowly relax and eventually have the arm in working condition—in a day or two, depending on the case.Other approaches that are not experimentally tested include eccentric exercise using a rubber bar. The exercise involves grasping a rubber bar, twisting it, then slowly untwisting it. Although it can be considered an evidence-based practice, long-term results have not yet been determined.There are differences in opinions on whether it is okay if pain occurs during these exercises. Some suggest pain of less than 5/10 is okay.Moderate evidence exists demonstrating that joint manipulation directed at the elbow and wrist and spinal manipulation directed at the cervical and thoracic spinal regions results in clinical changes to pain and function. There is also moderate evidence for short-term and mid-term effectiveness of cervical and thoracic spine manipulation as an add-on therapy to concentric and eccentric stretching plus mobilisation of wrist and forearm.