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Overview

Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.

Despite its name, athletes aren't the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters and butchers.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to a bony bump on the outside of your elbow. Pain can also spread into your forearm and wrist.

Rest and over-the-counter pain relievers often help relieve tennis elbow. If conservative treatments don't help or if symptoms are disabling, your doctor might suggest surgery.

Symptoms

• The pain associated with tennis elbow may radiate from the outside of your elbow into your forearm and wrist. Pain and weakness may make it difficult to:
  • Shake hands or grip an object
  • Turn a doorknob
  • Hold a coffee cup

Causes

Tennis elbow is an overuse and muscle strain injury. The cause is repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in a series of tiny tears in the tendons that attach the forearm muscles to the bony prominence at the outside of your elbow.

As the name suggests, playing tennis — especially repeated use of the backhand stroke with poor technique — is one possible cause of tennis elbow. However, many other common arm motions can cause tennis elbow, including:

• Using plumbing tools
• Painting
• Driving screws
• Cutting up cooking ingredients, particularly meat
• Repetitive computer mouse use

Risk factors

• Factors that may increase your risk of tennis elbow include:
  • Age. While tennis elbow affects people of all ages, it's most common in adults between the ages of 30 and 50.
  • Occupation. People who have jobs that involve repetitive motions of the wrist and arm are more likely to develop tennis elbow. Examples include plumbers, painters, carpenters, butchers and cooks.
  • Certain sports. Participating in racket sports increases your risk of tennis elbow, especially if you employ poor stroke technique.

Prevention

• Rest. Avoid activities that aggravate your elbow pain.
  • Pain relievers. Try over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve).
  • Ice. Apply ice or a cold pack for 15 minutes three to four times a day.
  • Technique. Make sure that you are using proper technique for your activities and avoiding repetitive wrist motions.

Treatment

Most people who have plantar fasciitis recover with conservative treatments, including resting, icing the painful area and stretching, in several months.

Medications

Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can ease the pain and inflammation associated with plantar fasciitis.

Therapies

Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include:

• Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist might also teach you to apply athletic taping to support the bottom of your foot.
• Night splints. Your physical therapist or doctor might recommend that you wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching.
• Orthotics. Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

Surgical or other procedures

When more-conservative measures aren't working after several months, your doctor might recommend:

• Injections. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture. More recently, platelet-rich plasma has been used, under ultrasound guidance, to provide pain relief with less risk of tissue rupture.
• Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. This procedure might cause bruising, swelling, pain, numbness or tingling. Some studies show promising results, but it hasn't been shown to be consistently effective.
• Tenex procedure. This minimally invasive procedure removes the scar tissue of plantar fasciitis without surgery.
• Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.