Tennis Elbow

Tennis elbow is an injury to the tendons attaching the forearm muscles to the outer part of the elbow. This injury comes from repetitive stress — in other words, a simple physical activity repeated over and over again, such as:

• Using a manual screwdriver
• Painting
• Raking
• And, yes, playing tennis

• Tennis elbow affects more men than women.
• Tennis elbow affects people of any age, but most patients tend to be between 30 and 50 years of age.
• Between 1 and 3 percent of the overall population has tennis elbow.
• Up to 50 percent of tennis players have tennis elbow (but less than 5 percent of tennis elbow cases are related to actual tennis).
• Golfers
• Baseball players
• Bowlers
• Gardeners or landscapers
• House or office cleaners
• Carpenters
• Mechanics
• Assembly-line workers

Repeated contraction of the forearm muscles used to straighten the hand and wrist, causing small tears in the tendons attaching the forearm muscles to the outer part of the elbow.

The following are the most common symptoms of tennis elbow. However, each adolescent may experience symptoms differently. Symptoms may include:

• Pain, especially over the outside area of the elbow
• Pain that gets worse when shaking hands or squeezing objects
• Pain with wrist movement
• Forearm weakness

The symptoms of tennis elbow may resemble other conditions or medical problems. Always consult your adolescent's physician for a diagnosis.

Your child's physician makes the diagnosis after a physical exam and a medical history. During the exam, your doctor may evaluate your child's forearm and wrist movement, apply pressure to the affected areas, or ask your child to describe their pain. X-rays may also be used to rule out other causes for your child's pain.

Specific treatment for tennis elbow will be determined by your child's physician based on:

• Your child's age, overall health, and medical history
• Extent of the injury
• Your child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

Most cases of tennis elbow are treatable with rest and pain medication only. However, NSAID pain relievers such as ibuprofen and naproxen should not be taken in the long-term, as these medications can cause the stomach to bleed internally.

Also, orthotic devices, such as straps and braces, may help relieve the stress on your child's arm.

At Boston Children's Hospital, we are now considering the latest in tendon regeneration with the application of Platelet Rich Plasma. This process has been popular in Europe and has been getting a lot of attention in the United States to enhance tissue regeneration in difficult to heel areas such as tendons. There are many healing growth factors normally in our platelets.

• The process involves drawing off the patient's own blood and isolating the platelets that contain these growth factors.
• This is then injected into the affected areas with ultrasound guidance.

This special procedure is performed by Pierre d'Hemecourt, MD, under ultrasound guidance.

• Perform warm-up and cool-down exercises before and after tennis play that includes stretching the muscles in the arm.
• Use appropriately-sized tennis equipment. Racquet handles and heads that are too big or too small or strings that are too tight or too loose can put more stress on the elbow.
• Evaluate poor tennis technique that may be contributing to the problem. Learn new ways to play that avoid repeated stress on the joints.
• Keep your wrist straight during lifting activity.
• Do strengthening exercises using hand weights.
• Ice down your arm after heavy use.

Most tennis elbow injuries are initially treated with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. NSAIDs should not be used for an extended period of time because they may cause internal bleeding in the stomach. About 10 percent of cases of tennis elbow are bad enough to require surgery, which has usually involved trimming or detaching/re-attaching the inflamed tendon. Boston Children's Hospital is one of a few centers in the world that uses platelet-rich plasma to help the tendons heal themselves. Furthermore, since tennis elbow is a repetitive stress injury, our doctors can help your child carry on with their activities in a way that won't tire or hurt their elbow.