Tennis elbow occurs when the muscles that extend the wrist become overused. These muscles attach to the bony part of the elbow. The tendon attaches the muscle to the bone. This is where the pain is located. Repetitive movements of the wrist strain these muscles and tendons. The pain is from inflammation initially (tendinitis). With time, however, the tendon develops degenerative changes and collagen breakdown. The pain is less from inflammation at this point and more from tendon dysfunction (tendinosis).
Treatment–Conservative
Treatment for tennis elbow is usually conservative. The first step is activity modification. This means reducing the activities that irritate and overuse the muscles. This allows the tendon to rest and heal. Anti-inflammatory measures are helpful too. Ice works great for the elbow. The usual anti-inflammatory medications can also help, such as ibuprofen and naproxen. Both are available over-the-counter.
First-line Treatment
Ultimately, for long-term relief the muscles and tendons that extend the wrist need to be strengthened. A key exercise is wrist extensor curls. In this exercise, the hand is slowly lifted up while holding a light-weight. Then, the weight is slowly lowered. Slowly lowering the weight is called the eccentric portion of the exercise. This type of strengthening, eccentric exercise, is very helpful to rehab tendons. Another option for relief is using a forearm brace around the tendons. It helps offload the tendons and reduce pain. Caution, however, as the brace is not a replacement for strengthening the muscles.
Second-line Treatment
If symptoms don’t improve with rest, anti-inflammation measures, and exercise, there are more invasive options. The more invasive options include different types of injections. For the elbow, there are steroid injections and a newer type called platelet-rich plasma. Steroid injections work great in the short-term but are not good for tendon health in the long-term. It is unclear how effective platelet-rich plasma is based on clinical studies, however, there are not any major harms currently known. If symptoms are still refractory to treatment, surgical intervention is a consideration.
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