One morning, you wake up and discover your elbow is hurting. Over the next several days, your pain intensifies, especially on the outside of your elbow and arm. You google your symptoms and find something called ‘tennis elbow.’ You typed up your daughters homework for her last night, but that was the only thing that was different this week. Could this pain be tennis elbow even if you don’t play tennis? The short answer is YES. Fortunately, most cases of tennis elbow aren’t related to a specific injury or trauma. Because of this, lateral epicondylitis is the most likely cause of your elbow pain.
What is Lateral Epicondylitis? The Anatomy
Lateral epicondylitis is elbow pain resulting from overuse in the tendon where your forearm muscles attach to your arm bone. Additionally, micro-tears in the region contribute to this tendon irritation.
Where Does it Hurt?
Patients with lateral epicondylitis report pain in the forearm and near the outside of the elbow, especially with specific movements of the wrist and hand. Straightening the wrist and fingers or turning the palm upward will typically recreate the pain in the elbow. On the other hand, when the elbows remain bent, pain is usually alleviated. The area over the tendon attachments is also sore to the touch.
Who Does it Affect?
Lateral epicondylitis affects about 1-3% of the general population and up to 51% of all tennis players.² While the condition primarily affects middle age people (30-50 years old), it can occur at any age depending on the sport you play or the work you do everyday.
How and Why Did I Get Lateral Epicondylitis?
Repetitive forearm activity is the biggest risk factor for tennis elbow even though the exact pathophysiology is unknown. For example, playing an instrument, typing, tennis, or repetitive manual work are activities that increase your risk of tennis elbow.
Poor posture is also a risk factor for lateral epicondylitis, which is why lateral epicondylitis is common for people who have desk jobs. Similarly, your elbow pain could be a compensation for an issue at another joint, such as shoulder immobility or rotator cuff weakness.
These impairments lead to increased strain on the extensor tendons of the wrist, which attach in your elbow. The good news is lateral epicondylitis is a self-limiting condition. Surgery is not indicated usually, and pain resolves with activity modification and physical therapy.
Other Possible Elbow Diagnoses
Lateral epicondylitis is the most common cause of outer elbow pain, but it is important to consider other diagnoses. First, radial tunnel syndrome shares similar symptoms to lateral epicondylitis. However, it is more of a nerve compression than an irritated muscle. Different tests on physical exam can differentiate between the two. Second, adolescents may experience pain from a joint disorder known as osteochondritis dissecans. Cracks form in the cartilage around the elbow, especially in young athletes who weight-bear on their hands, like gymnasts. Finally, osteoarthritis or rheumatoid arthritis can also cause elbow pain as well as loss of range of motion, swelling, and/or redness.³
Radiating Elbow Pain
The neck and shoulder need to be evaluated to check for joints that are known to refer pain to the elbow. Like lateral epicondylitis, cervical radiculopathy (nerve root compression in the neck) can cause pain in the elbow and forearm, but it is treated differently. Primary shoulder diagnoses such as subacromial impingement, rotator cuff tears, and arthritis can also cause pain to radiate into the upper arm and outer elbow.
Physical Therapy Evaluation
A comprehensive physical therapy evaluation is performed to diagnose the source of your elbow pain. This includes an assessment of the painful area and all adjacent joints. Assessing the joints around the elbow helps pin point the root cause of the elbow pain. If findings are consistent with lateral epicondylitis, a variety of hands-on treatment techniques are used, including joint mobilizations and Gua-sha (an instrument-assisted soft tissue technique for pain relief).
In cases where findings are consistent with another disorder, such as cervical radiculopathy, a different type of treatment is indicated. This will be prescribed accordingly. Schedule your appointment now to be evaluated by our specialist if you are unsure why you have elbow pain.
- Shift N, van der Windt DA. Tennis elbow in primary care. BMJ 2006; 333:927-928.
- Renstrom, P., & Ackermann, P. W. (2018). Pathophysiology of Tendinopathy: Implications for Tennis Elbow. Tennis Medicine, 263–275. doi:10.1007/978-3-319-71498-1_18.
- Alfonso Vaquero-Picado, Raul Barco, and Samuel A. Antun. Lateral epicondylitis of the elbow. EFORT Open Rev. 2016 Nov; 1(11): 391–397. doi: 10.1302/2058-5241.1.000049.
- Herquelot E, Bodin J, Roquelaure Y, Ha C, Leclerc A, Goldberg M, et al. Work-related risk factors for lateral epicondylitis and other causes of elbow pain in the working population. Am J Ind Med. 2013;56(4):400–9. Epub 2012/11/16. 10.1002/ajim.22140