Understanding Lateral Elbow Tendinopathy

Lateral elbow tendinopathy is a common type of elbow injury. It is often found in people who play tennis or golf, especially those who are elite players who practice often. This condition involves the tendons in this area, which are tough bands of tissue that help to connect the bones to the muscles. Tendon related problems may occur for various reasons, such as repetitive activities and trauma to the area.

Tendon injury can cause pain, inflammation, and difficulty using the joint. This is often referred to as tendonitis. It is common in people as they get older but is most common in situations of overuse. Some conditions, like rheumatic disease, can also bring on this condition, but that occurs less commonly. Repetitive motion related injuries are far more common.

What Occurs to Create This Concern

In lateral elbow tendinopathy, LET, an overuse injury happens. For example, it is very common for this type of injury to occur in tennis players because they overuse the elbow during practice and in play. LET most often commonly involves extensor carpi radialis brevis. This occurs because of overuse of the wrist extensor and the supinator.

In the game of tennis, there are many things that can happen to cause LET to occur. For example, it may be brought on by excessive load or the size of the racquet handle. In some situations, it is more common because of the racquet’s weight. It is also quite commonly associated with a player using poor technique. This may include, for example, a player engaging in leading elbow. This occurs when an open racquet face is present at the time of the ball’s impact, and that impact typically happens on the bottom half of the strings.

Another core reason LET can develop, it is believed, is due to the transfer of shock from the tennis racquet to the elbow itself. The shock transmits into the elbow, causing significant pain to develop. This is most likely to happen in patients who have greater wrist extensor activity when the ball makes impact with the racquet or during the early follow through. Shock is also believed to be a big reason for this condition development because some players, especially those with a double handled backhand, do not develop it. In these players, their nondominated hand takes on more of that shock and reduces any transfer to the elbow.

Dr. Brian Cable, MD, provides some insights. “It is somewhat common for tennis players to develop this condition due to poor positioning and technique in the game. It can also occur as a result of the intense amount of shock that happens when the ball hits the racquet. That shock must go somewhere, so it travels through the racquet and into the elbow. This can create significant pain and limitations on movement for some people.”

Typical Symptoms of LET

There are a wide range of risks that can occur to the elbow, but a few specific symptoms indicate LET is the underlying cause of the pain and mobility issues.

Most people with LET experience pain that is over the lateral elbow. They describe this pain as radiating into the forearm. This type of pain may also cause a decrease in grip strength. It is not often beneficial to use traditional imaging methods to see this type of pain because there may be limited evidence on it. That is why the symptoms of LET are quite important in diagnosing this condition.

Some people experience:

• Pain in the elbow tends to spread upward to the upper arm or that spreads downward into the forearm.
• The development of weakness in the forearm
• More difficulty with tasks that require strength in the arm, including tennis and golf, or hitting backhand
• The pain can come on suddenly in some people, but for others, it can gradually develop over time.

What Type of Treatment Options Exist for LET?

Elbow tendinopathy treatment is often based on a person’s specific limitations and needs. The use of rehabilitation exercises may be one of the best ways to improve LET. Injections into the elbow do not provide any type of long-term effects, though it may help with pain relief for a short amount of time. The better option then is to engage most patients in improving the function and strength of these tendons. There is also some promise in platelet-rich plasma (PRP). This works to help encourage the healing of the area and can help to restructure the area over the long term.

The immediate solution may be to work to alleviate pain, but doing this does not mean a person can go back to engaging in those same activities right away. More advanced treatment may be necessary for some individuals. Arm braces may be used in some. Rehabilitation and physical movement may also help.

A correction of the underlying problem is also important. For example, making changes to the racquet size to better accommodate the person or improving technique can help to minimize these risks. In some players, it is critical to take a more advanced treatment approach which could include the use of surgery.

Elbow tendinopathy can be improved in many people. That may mean being able to get back at playing their favorite game or simply engaging in activities without the need to struggle with pain and mobility concerns. The key here is the proper understanding of the condition and the selection of the best treatment plan.