Tennis elbow, or lateral epicondylitis, is an overuse injury to the tendons that originate at the outside of the elbow. Tendons are like ropes which connect the ends of muscles to bone. The tendons affected in tennis elbow attach the muscles of the forearm to the humerus (upper arm bone). Children rarely get tennis elbow. It is most common in adults but can affect adolescents as well.
Overuse of these forearm muscles causes fraying of the tendon. Despite the name, tennis elbow does not only occur in tennis elbow. Individuals engaged in any activity which involves repetitive motions of the wrist and forearm, including golf and other racquet sports, are at risk for this condition. With tennis, the stress is greatest on the outer elbow of the dominant arm during a backhand swing. Incorrect grip size or swing mechanics can contribute to the injury.
Your child may have pain in the elbow during or after activity without significant swelling or redness. The pain may travel down the forearm. Pain usually begins gradually without one specific injury to the joint. The pain may improve with rest but often returns when the activity (such as tennis) is resumed. Some individuals notice decreased grip strength on the affected arm.
Your child’s doctor will examine the elbow, forearm and wrist on the affected side. X-ray films are rarely needed to make the correct diagnosis, but your doctor may order an x-ray or other imaging studies to rule out other conditions if the diagnosis is unclear.
Treatment depends on the severity of your child’s symptoms. Your physician will likely prescribe a period of rest, or at least “relative rest” (decreased activity using the forearm and wrist). Eccentric strengthening exercises (exercises which strengthen the muscle as it lengthens) have been shown to decrease symptoms in patients with tendon irritation and fraying. Your physician may recommend that you see a physical therapist to learn eccentric strengthening and stretching exercises. Bracing the elbow or wrist may also help decrease symptoms. Non-steroidal anti-inflammatory medications (NSAIDs) and other over-the-counter pain medications can be used temporarily to alleviate symptoms.
Tennis elbow symptoms often persist as long as 9 to 12 months. If your symptoms are prolonged and severe, your physician may recommend an injection to the area. Surgery is reserved for severe cases that do not respond to other treatments.
The goal is to have your child participating in their sports or activities as quickly and safely as possible. If your child returns to activities too soon or plays with pain, the injury may worsen. Pain in the elbow with daily activities is a sign of more severe injury and should prompt a longer period of rest. Your child’s physician may allow your child to gradually re-introduce the sport or activity (such as tennis) once the pain is being managed effectively or has resolved with treatment. They may recommend activity modification initially (e.g., playing doubles matches in tennis instead of singles).
For young athletes, attention to proper technique and equipment can help prevent tennis elbow. If you have had tennis elbow in the past, continuing with stretching and eccentric forearm strengthening may prevent the return of this condition. Tight muscles put more stress on the attached tendons and bones, putting these tissues at risk for injury. The ideal time to stretch is after a workout.