Tennis Elbow

By Ray



This is one of a number of Medical Checkpoints giving information about common conditions and what you can do about it. Your opinion and reaction to these Medical Checkpoints would be valued and appreciated. Medical Checkpoints are published periodically by STARTHealthcare and are provided as a free service.



The following definition is taken from Samuel L. Turek's textbook Orthopaedics 4th Edition page 971:

The syndrome of chronic disabling pain in the elbow, particularly about the radiohumeral articulation, is designated tennis elbow rather than epicondylitis or radiohumeral bursitis in view of lack of specificity regarding its origin.


In common usage definitions all three terms may be applied to the same symptom complex, e.g. tennis elbow, lateral epicondylitis, or radiohumeral bursitis.


What is going on:

There is a family of conditions called "traction syndromes" that share common causative factors. Tennis elbow, jumper's knee, policeman's heel (heel spur), greater trochanteric pain syndrome, rotator cuff syndrome and coccydynia may all be members of this family. What they have in common is a strong fascial or tendinous-bony attachment with repetitive stress at that site. While much about the cause of these traction syndromes may not be known, it seems reasonable to consider their cause as follows: A few fibers of the tendon or muscle-tendon-bone junction is stretched beyond its elastic limits or torn microscopically which initiates the normal repair inflammation. In the majority of instances this stretch or tear will heal painlessly or with minimal discomfort. However, due to many possible causes, e.g. repetitive stress before healing is complete, healing in a contracted position where the next significant stress tears the newly healed, contracted fibers, general body fatigue or mental stress, or suboptimal nutritional status contributes to incomplete or poor healing that breaks down with the next significant stress. This starts the repair cycle all over again with the potential for chronic pain at the site of inflammation. There is no muscle weakness. The perception of weakness is due to pain limitation. Xray examination, at least in the early stages, is perfectly normal. If the torn tissue dies before it is repaired, sometimes calcification can be seen on Xray. The laboratory tests are normal. It appears, at times, that the only evidence that something is wrong is the patient's complaints of pain which can be increased by local palpation over the site of inflammation. The usual symptoms are pain and perceived weakness with lifting a cup, turning a doorknob, or any activity with the painful elbow. Activity that combines elbow or wrist extension aggravates the pain. Local tenderness to palpation over the muscular-bony part of the elbow is also often felt.

The traction syndrome family is not arthritis, but is often associated with the common variety of osteoarthritis. Decreased microscopic local blood flow may be the mechanism in common with all of these conditions.



What to do:

These conditions are characteristically resistant to treatment, particularly if all the focus of treatment is directed to the site of pain. A whole-body treatment plan including general exercise such as walking and a high fiber diet is often rewarded with success. The importance of high fiber nutrition (e.g.whole plant diet) and general exercise in the out-of-doors cannot be stressed too greatly.


1. The first thing to do is to establish the diagnosis. Is your elbow pain due to tennis elbowor not? It is imperative that the correct diagnosis be made. For this purpose see your doctor.


2. Rest is the cornerstone of treatment for these traction syndromes. However each member of this family has its own features including treatment. Having established the diagnosis, perhaps the most important fact to understand is that pain per se is not doing irreparable damage. The worst thing about the pain is that it is unpleasant. The pain does have the advantage that it warns you to protect the painful elbow. Pain is the body's way of saying: "Please rest me!" Do not rest the arm in a sling. This will usually only reward your efforts with a stiff shoulder in addition to a painful elbow. The best rest for tennis elbow is to use the elbow normally for all activities that do not aggravate the pain, and put the elbow and wrist through a full range of motion at least once a day. When healed, increase the activities that were painful, little by little.


3. Local heat will have the effect of making the elbow feel better while promoting healing. Alternate hot and cold applied locally will increase the blood flow to the part and have the effect of "washing out" the collection of pain chemicals while bringing in the needed repair substances. Heat will ease the pain and relax the muscles allowing for more normal local blood flow. There are a number of easy ways to apply hot and cold to the part (e.g. 3 min hot and 1/2 min cold): - shower or water baths or heating compress or electric pad and ice locally. Use a thermometer to measure the heat of the hot water. Start the hot water about 100F (37.7C) and increase the temperature by adding more hot water (without burning yourself) to a maximum temperature of 110F (43C). Add ice to the cold water to keep it cold and end the treatment with cold (at least three hots and three colds). If you have diabetes, peripheral neuritis, or other disease that makes your body part insensitive to temperature consult your professional medical providers before attempting to use hot and cold on yourself.


4. Local massage (e.g. rubbing where it hurts with the thumb or fingers, back and forth and in a circular motion) may increase the pain at the time of treatment but may "feel good while it hurts". This is often subconsciously done just because it makes it feel better. Massage increases the local blood flow. The local fluid collection, edema, caused by the inflammation, is pressed out by massage. The warmth of the hand used for massage increases the local temperature which also makes the elbow feel more comfortable. Deep massage of this type tends to stretch the fibers and prevent healing in the contracted position and promote healing in the stretched position which is desirable.


5. Protection from chilling is most important with elbow pain. The elbow tends to be exposed with little or no covering of subcutaneous fat. A protective sleeve often gives good relief from pain, partly by keeping the elbow warm, and promoting rest. Wearing long sleeves also helps.

6. If all else fails before considering surgery see what an anti-inflammatory diet will do for you. What is an anti-inflammatory diet? Foods that come from plants. The less refined the food the better. Why are plant foods anti-inflammatory? It is because of the chemical messengers that are in plant foods (ecosinoids and prostaglandins) all have the effect of decreasing inflammation in our bodies. Try it. It will work! Why do I want to eat an anti-inflammatory diet? It will give you less pain. Pain comes from inflammation. It will also give you less blood clotting tendency for your blood. That would be nice!



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