Section 5. Bone, Joint, and Muscle Disorders

Chapter 75. Sports Injuries

Topics: Introduction | Stress Fractures of the Foot | Shin Splints | Popliteus Tendinitis | Achilles Tendinitis | Runner's Knee | Hamstring Injury | Lateral Epicondylitis | Medial Epicondylitis | Rotator Cuff Tendinitis

Lateral Epicondylitis

Lateral epicondylitis (backhand tennis elbow) is damage to the tendons that extend or bend the wrist away from the palm, causing pain in the elbow and on the outer, back side of the forearm.

The forearm muscles that are attached to the outer part of the elbow become sore when excessive stress is placed on the point of attachment. Lateral epicondylitis is most often felt during a backhand return, but can be felt during sports other than tennis. The force of the racket hitting the ball can damage the tendons where they are attached to the lower end of the upper arm bone. Factors that increase the chance of developing lateral epicondylitis include using improper backhand strokes (called leading elbow backhand), having weak shoulder and wrist muscles, playing with a racket that is too tightly strung or too short, hitting the ball off center on the racket, and hitting heavy, wet balls.

See the figure Tennis Elbow.

The first symptom is pain during a backhand stroke or other similar repetitive movements. Pain may occur with any exercise that requires extension of the wrist. The elbow hurts when the person places the arm and hand palm down on a table and tries to raise the hand against resistance by bending the wrist. Pain is felt along the outer, back side of the elbow and forearm on the same side as the thumb when the hand is by the side with the thumb away from the body. Continuing to play can extend the area of pain from the elbow down to the wrist and result in pain even at rest.

Treatment consists of applying ice and avoiding any exercise that produces pain. Exercises that do not use the wrist extensor muscles primarily, such as jogging, cycling, or basketball, can be substituted to maintain physical fitness. As the injury heals, flexibility and strengthening exercises can be started. Generally, all the muscles that bend and straighten the wrist should be strengthened. When lateral epicondylitis occurs persistently, a corticosteroid may need to be injected at the tendon that bends the elbow (flexor tendon), but exercises and altered use of the elbow are still needed or the problem will recur. The use of a brace may be helpful.