Tennis Elbow-by Vic Goradia, M.D.

The red dot is the site for tennis elbow pain

Tennis elbow is an injury to the muscles and tendons on the outside (lateral aspect) of the elbow. It typically results from overuse or repetitive stress, but it occasionally results from a trauma. And it is not just seen in tennis players -- the injury occurs because of the nature of the tendon at this level of the elbow.

The extensor tendons, which are the tendons that enable you to straighten your fingers, narrow at the lateral aspect of the elbow. The high stress localized at this site can exceed the tendons’ ability to recuperate and over time may be result in injury.

Lateral Epicondylitis

Injury to the lateral aspect of the elbow (pictured at right) is the most common upper extremity tennis injury. Tennis elbow is generally caused by overuse of the extensor tendons of the forearm.

Commonly experienced by the amateur player, this injury is often a result of:

A one-handed backhand with poor technique (the ball is hit with the front of the shoulder up and power generated from the forearm muscles)

A late forehand swing preparation with resulting wrist snap to bring the racquet head perpendicular to the ball

Or, while serving, the ball is hit with full power and speed with wrist pronation (palm turned downward) and wrist snap that increases the stress on the already-taught extensor tendons.

While popularized in tennis players, the majority of patients with tennis elbow symptoms are not tennis players at all. Jobs that require repetitive stress at the elbow can often cause subtle injuries over time. Sometimes patients may experience pain and not have a history of repetitive trauma at all. This is mostly due to the normal aging process of tendons.

As we get older, tendons that are under high stress -- such as elbow tendons, rotator cuff tendons and Achilles tendons -- tend to lose their blood supply. In turn they lose their elasticity and healing potential. So what may be perceived as normal everyday activity may actually injure a tendon that is not quite healthy.

Medial epicondylitis

Medial epicondylitis is less common and characteristically occurs with wrist flexor activity and pronation (a gripping-like motion). Medial epicondylitis can result from:

• Late forehand biomechanics where the player quickly snaps the wrist to bring the racquet head forward


• The back-scratch or cocking phase when serving, which places tremendous stress on the medial tissues of the elbow


• In the right elbow of a right-handed golf swing by throwing the club head down at the ball with the right arm rather than pulling the club through with the left arm and trunk (referred to as "golfers elbow")


• Or improper pulling technique with certain swim strokes, especially the backstroke (referred to as "swimmers elbow")