Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

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Tennis elbow usually presents as tenderness and pain in the elbow and weakness of the hand. The weakness is due to discomfort when gripping objects, not to true muscle weakness.

Tennis elbow occurs more often in non-athletes than in athletes. Housewives, factory workers, golfers, carpenters, and politicians doing a lot of handshaking are all prone to it.‍

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TREATMENT‍

1. Rest for three to four days is essential. Rest does not mean total immobilization, as immobilization leads to muscle shrinking; rest means elimination of the activities that cause pain.
2. Ice may be applied for 30 to 90 minutes daily, depending on the severity of the pain. Some patients find heat more soothing, particularly after the first few days.
3. Avoid cortisone injections, as they may cause tendon atrophy or actually dissolve the tendon.
4. Rest alone is generally not adequate to cure tennis elbow. Exercise is very important, and will help to prevent recurrences. A hand gripper may be used five to ten minutes four times a day. The elbow should be straight, and the wrist bent to stretch the extensor tendons and aid in strengthening fibrous tendons.
5. Vigorously rubbing the elbow and forearm may be helpful.
6. Fourteen of eighteen patients on a four- to five-week program of resistive exercise received complete pain relief. Place the arm on a table, palm down, gripping a three-pound dumbbell. Flex the wrist upward with a slight radial deviation, and hold for five seconds. Return to starting position and rest three seconds. Increase the weight one pound when the exercise can be performed 15 times with ease. Continue increasing weight until eight to ten pounds can be lifted without pain. This generally requires four to six weeks of daily exercise. To strengthen the forearm rotators, start with the arm downward and rotate the forearm 180 degrees bringing the palm upward and the dumbbell into the horizontal position. Repeat each exercise 15 times.
7. An isometric exercise is reported to prevent tennis elbow. Attempt a backhand swing, while holding the throat of the racket with the non-playing hand. Gradually increase the strength of the pull.
8. Many players report relief by placing a band several inches wide around the forearm near the elbow and another just above the wrist. Be certain the bands are not so tight that they interfere with blood flow.
9. A lighter racket with a larger grip, not too tightly strung, may help. Some aluminum or fiberglass rackets may cause less pain than wooden ones.

Rubbing or warming the arm just prior to playing may increase pain tolerance limits.