Anatomy
On the outside or lateral aspect of the elbow is a bony prominence, or projection, called the lateral epicondyle.  The tendons that extend or straighten the wrist and fingers attach to this bony prominence.
Injuries that result in a slight tearing of the fibers that attach here can result in a degeneration of this connective tissue and cause pain.  Because this type of problem was first noted frequently in tennis players, it has been dubbed "tennis elbow," although in actuality few of the individuals afflicted with this problem are tennis players.  More often the problem occurs in the workplace, and with those individuals who use the hand and wrist for repetitive forceful activities.

Symptoms
A characteristic of this condition is that activities such as lifting a bag of groceries, gripping a racquet or some other object, or pinching firmly will produce pain in the region of the outside of the elbow.  Such pain is often worse at the beginning of use or exercise and may subside to some extent once the extremity is "warmed up."
Once the condition becomes severe, however, this may not occur.  Instead, the entire area becomes sensitive to the touch, and bending the wrist back or extending it against resistance increases the pain.

Conservative Nonsurgical Treatment
The vast majority of patients with lateral epicondylitis can be treated by simple methods.  These include warming up the elbow with hot packs or other means, prior to use, and applying ice after use.  This is combined with therapy, and often specific stretching exercises are helpful.  Such a program can be overseen by a therapist, and regular visits to the therapist can be combined with a home therapy program.  Sometimes more-intensive therapy and additional visits to the therapist are needed.
Stretching exercises, as well as strengthening, and a process called iontophoresis, applied by the therapist onto the skin, or ultrasound, may be helpful.
Also, judicious use of antiinflammatory medications, taken orally as prescribed by a physician, may alleviate pain.
A counterforce brace, which is a broad band applied to the forearm musculature just distal to the elbow, may relieve some of the stress on the lateral epicondyle attachment and substantially ameliorate the symptoms.  Also, a wrist splint may rest the muscles of the forearm, and night splinting of the wrist may be beneficial.
A cortisone injection into the area will often provide significant relief.  There is very little risk in giving such injections, and they are usually the most effective way of treating lateral epicondylitis.
Most important, in conjunction with each of these conservative methods of treatment, however, is modification of activities to avoid the injurious exposure or activity that gave rise to the condition.  Most individuals with lateral epicondylitis will improve, and the problem will ultimately resolve, with both a modification of activities and one or more of the above methods of treatment.

Surgical Treatment
If there is ongoing severe symptomatology to the point where the individual is unable to perform daily activities and cannot work and it is evident that conservative care has definitely failed after a long time, then surgery may be indicated.
We believe that, among the several operations described for lateral epicondylitis, a debridement procedure of the degenerative material around this portion of the elbow tendon attachment is the best and usually results in substantial relief of symptoms.
Tennis elbow produces some swelling in this part of the upper extremity, which is close to the radial tunnel, the area through which the radial nerve travels at the elbow.  Therefore, lateral epicondylitis is often associated with radial tunnel syndrome.  In fact, radial tunnel syndrome should be tested for in all patients who have lateral epicondylitis, and, especially if surgery is needed, the radial tunnel should be treated at the same time to obtain a cure of the problem.

Healing after Surgery
Following surgery, it is essential that the patient be involved in a carefully monitored therapy program to slowly increase activities and strength.  It may take several months for this process to run its course and for adequate strength to return to allow normal use.

Information about the related radial tunnel syndrome can be found at our page.