What is it?
Lateral Epicondylitis is commonly referred to as "tennis elbow" because of the high incidence of this injury in athletes who participate in racquet sports. It is also seen in the throwing athlete. Lateral Epicondylitis is considered to be the one of the most frequent overuse injuries in athletes, as well as the most common injury of the adult elbow.

It hurts Where?
Well…let's break it down! An epicondyle is a bony prominence located on either side of the elbow. You have two of them, one on the inside of the elbow and one on the outside. Since lateral means outside, the pain is usually right around the bony prominence on the outside of the elbow. The pain often extends from the lateral epicondyle, down into the forearm. It is often sensitive to touch directly over the lateral epicondyle and the surrounding muscles and tendons.

How does it happen?
Lateral Epicondylitis is a repetitive overuse injury of the wrist extensor muscles. These are the muscles that pull your hand up (as if you were singing "stop in the name of love")…you get the idea. Anyway, this injury comes on gradually and is not the result of a single incident. The direct cause depends on the sport activities of the athlete. It is often attributed to the deceleration phase of throwing, as well as many variables in racquet sports. For instance…too tight of a grip, improper grip size, too much string tension, too heavy of a racquet and improper backhand technique. Needless to say the repetitive stresses eventually cause inflammation and microtears of the extensor tendons which attach to the lateral epicondyle, therefore causing pain on the outside of the elbow and forearm.

Injury Progression...
Initially the athlete will only complain of pain while participating in aggravating sport activities, this is considered stage 1. As the injury progresses, the athlete will begin to complain of pain when picking up a coffee cup or grabbing a gallon of milk out of the refrigerator (or similar), this is considered stage 2. If the injury progresses beyond this point the athlete will complain of elbow pain at all times…a constant discomfort, even at rest. The athlete will most likely demonstrate strength deficits of the upper extremity. This is considered stage 3, if the athlete gets here it's definitely time for a visit to the orthopedist.

Similar Injuries:
Lateral Epicondylitis is a pretty clear-cut diagnosis, however additional overuse injuries of the elbow include medial epicondylitis, elbow osteochondritis dissecans and "little league elbow". Medial epicondylitis is marked by pain and tenderness on the inside of the elbow and is commonly referred to as "golfer's elbow". Elbow osteochondritis dissecans is seen in the younger athlete (10-15 years old) who complains of pain and locking in the elbow. "Little League Elbow" is the result of repetitive throwing in the young athlete. Complaints of locking/catching of the elbow and development of a flexion contracture are signs of this injury.

Treatment:
Initial treatment is aimed at reducing the athlete's complaints of pain. Ice is always a good idea to help decrease inflammation. Other modalities that may be used include ultrasound, phonophoresis, iontophoresis and transverse friction massage. The athlete's rehabilitation should be pain-free at all times. PROM/stretching exercises of the elbow, wrist and forearm are a good place to start, followed by AROM exercises. As the athlete begins to show signs of improvement, treatment can progress to include pain-free strengthening activities…usually isometrics first and then isotonic exercises (Thera Band, putty, gripping activities, tennis ball squeezes). In some instances, the athlete may experience relief with the use of a counterforce brace, which is to be worn 2-3 inches below the elbow. This will limit excessive tension on the inflamed muscles (in theory, at least). In all cases, it's important to get to the root of the problem, so it's a good idea to take a look at the biomechanics of the athlete's sport specific skills and make adjustments where necessary. Time off from aggravating activities is almost always necessary with this injury.

Participation Status:
Athletes in stage 1 may continue to participate in sport activities as tolerated, but should begin rehabilitation and use ice regularly. Athletes in stage 2 will have limited participation allowing for more prolonged rest of the wrist extensors, but must also participate in a rehabilitation program. The athlete that presents with signs and symptoms consistent with Stage 3 should be out of participation completely and begin a regular rehabilitation program. If the symptoms do not improve within 2 weeks of treatment, the athlete should be referred to an orthopedist. If conservative treatment is not successful, an orthopedist may consider anti-inflammatory medication or corticosteroid injections. The absolute last resort is surgery, which has been shown to be very effective.