A common cause of pain in the elbow is what is commonly known as 'tennis elbow', although the injury can also occur in golf, baseball, all racquet sports, rowing, canoeing, weightlifting, hockey, wrestling and swimming, as well as a variety of occupations.

There are 3 distinct bumps in the elbow joint. The largest one is on the back of the elbow and is not important in 'tennis elbow'. There are two less distinct bumps, one on the inside, called the "medial epicondyle" and one on the outside, called the 'lateral epicondyle'. Hence, the medical terms, 'lateral epicondylitis' when the pain is on the outside bump and 'medial epicondylitis' when the pain is on the inside bump. Pain may also be felt in the muscles that attach to these bumps, and in fact, the muscles and their attachments are the real cause of the injury.

Injury occurs gradually as small injuries occur repeatedly to the same area. These small injuries may result from:
1. An accustomed use.
2. Improper technique (e.g. tennis elbow, leading backhand, pitching curve balls in baseball).
3. Improper or unsuitable equipment, e.g. tennis racquet - handle may be too large, the strings may be too tight, the racquet may be too heavy.
4. Lack of strength in the forearm muscles.
5. Lack of flexibility in the wrist and elbow.

These small injuries (microtrauma) may not be noticed or only give minor discomfort but over time causes gradual damage where the muscle attaches to the bone. This is when the symptoms of the injury may occur.

1 . Pain on straightening elbow.
2. Pain when attempting to curl fingers and/or wrist (for medial epicondylitis) or straighten fingers and/or cock wrist (for lateral epicondylitis).
3. Point tenderness.
4. Inability to grasp and/or lift an object, e.g. saucepan, book, etc. or pain while doing it.

If the problem is a minor discomfort or a gradual onset of symptoms, ice alone may be used. Ice can be applied by:
1. Ice massage - fill a styrofoam or paper cup with water and freeze overnight. Peel the paper away from the ice block and gently rub over entire area of the bone and muscle. Do this for 15 minutes.
2. Ice packs - wrap CRUSHED ice in a damp towel and wrap on to the elbow with an elastic non-adhesive bandage. Leave on for 15-20 minutes.
3. Ice immersion for 15-20 minutes.

The goal of treatment is to reduce the inflammation, aid in complete healing, and prevent recurrence of the injury by identifying and correcting the cause of the injury. Treatment may include:

1. Medication Your doctor may prescribe an anti-inflammatory medication. You must take this as prescribed by your doctor. As well, he may suggest an anti-inflammatory medication taken half an hour prior to sporting activity for a short time to prevent the return of the inflammatory response.

2. Physiotherapy Your doctor may refer you to a physiotherapist. This is a very important part of your recovery as physiotherapy will assist a rapid and complete healing of the injury as well as attempt to prevent a recurrence.
It may include:
a) ice and exercise treatments
b) heat treatments
c) ultrasound
d) electrical muscle stimulation
e) combination of ultrasound and muscle stimulation
f) strength and flexibility exercises.

Strength
a) bending and straightening wrist
b) squeezing a tennis ball
c) finger exercises
d) broom handle exercises

Flexibility 3 sets of 10 for each exercise - hold each one for 6-10 seconds. Gently and slowly stretch only to point of discomfort, not pain. Do at least once daily.

Sometimes a brace worn around the forearm has been effective in treating 'epicondylitis'. The brace, or stretchy tape, is applied around the widest part of your forearm and worn during the activity (tennis, golf, etc) that originally caused the pain.
Normally, the brace should be worn for progressively less time until it need not be worn at all.
Successful physiotherapy and practice of preventive measure should make the use of a brace needless.