Tennis elbow

Diagnosis

Often, medical history and an exam are enough to diagnose tennis elbow. During the physical exam, a health care provider might press on the affected area or ask you to move your elbow, wrist and fingers in various ways.

X-rays, sonograms or other types of imaging tests might be needed if a care provider suspects something else might be causing the symptoms.

Treatment

Tennis elbow often gets better on its own. But if pain medicines and other self-care measures aren't helping, physical therapy might be the next step. A procedure, such as a shot or surgery, might help tennis elbow that doesn't heal with other treatments.

Therapy

If symptoms are related to tennis or job tasks, an expert might look at how you play tennis or do job tasks or check your equipment. This is to find the best ways to reduce stress on injured tissue.

A physical, occupational or hand therapist can teach exercises to strengthen the muscles and tendons in the forearm. A forearm strap or brace might reduce stress on the injured tissue.

Surgical or other procedures

• Shots. Different types of shots into the affected tendon are used to treat tennis elbow. They include corticosteroids and platelet-rich plasma. Less commonly used are botulinum toxin A (Botox) or an irritant solution, either sugar water or salt water, known as prolotherapy.

  Dry needling, in which a needle gently pierces the damaged tendon in many places, also can be helpful.

• Needle fenestration. This procedure uses ultrasound to guide a needle through a numbed tendon again and again. This starts a new healing process in the tendon.
• Ultrasonic tenotomy, called a TENEX procedure. Similar to needle fenestration, this procedure uses ultrasound to guide a special needle through the skin and into the damaged part of the tendon. Ultrasonic energy vibrates the needle so fast that the damaged tissue turns to liquid. It then can be sucked out.
• Extracorporeal shock wave therapy. This treatment involves sending shock waves to injured tissue to relieve pain and help the tissue heal. A tool placed on the skin delivers the shock waves.

• Surgery. For symptoms that haven't improved after 6 to 12 months of other treatments, surgery to remove damaged tissue might be an option. The surgery might be open, which uses a large cut, known as an incision. Or it can be done through several small openings, known as arthroscopic.

  Whatever the treatment, exercises to rebuild strength and regain use of the elbow are vital to recovery.

Lifestyle and home remedies

The following self-care measures might relieve tennis elbow:

• Rest. Do not do activities that aggravate elbow pain.
• Pain relievers. Try pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
• Ice. Apply ice or a cold pack for 15 minutes 3 to 4 times a day.

Preparing for your appointment

You'll likely start by seeing your health care provider. You might then go to a sports medicine specialist or an orthopedic surgeon.

What you can do

Before your appointment, you may want to have answers to these questions:

• When did your symptoms begin?
• Does any motion or activity make the pain better or worse?
• Have you recently injured your elbow?
• What medications or supplements do you take?

What to expect from your doctor

Your health care provider may ask some of the following questions:

• Do you have rheumatoid arthritis or a nerve disease?
• Does your job involve repetitive motions of your wrist or arm?
• Do you play sports? If so, what types of sports do you play? Has your form ever been evaluated?