Houston Methodist. Leading Medicine

Elbow FAQ

Question:

I just saw the local clinic's physician's assistant. He says I have tennis elbow even though I don't play tennis and don't know how I got this condition. I'm wondering if that's what's really wrong with me. How can they tell that without even doing an X-ray or MRI or something?

Answer:

Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players. The backhand swing in tennis can strain the muscles and tendons of the elbow in a way that leads to tennis elbow. But many other types of repetitive activities can also lead to tennis elbow: painting with a brush or roller, running a chain saw, and using many types of hand tools. Any activities that repeatedly stress the same forearm muscles can cause symptoms of tennis elbow. Reaching across the computer keyboard to use the mouse is one of the more common causes of this problem in patients today. Your doctor will first take a detailed medical history. You will need to answer questions about your pain, how your pain affects you, your regular activities, and past injuries to your elbow. Many other types of information may be gathered such as treatment tried so far, tobacco use, work history/sick leave, and time spent in leisure or recreational activities. A detailed physical exam is often most helpful in diagnosing tennis elbow. Height, weight, health status, pain assessment, strength, and motion may be measured and recorded. Your doctor may position your wrist and arm so you feel a stretch on the forearm muscles and tendons. This is usually painful with tennis elbow. There are also other tests for wrist and forearm strength that can be used to detect tennis elbow. You may need to get X-rays of your elbow. The X-rays mostly help your doctor rule out other problems with the elbow joint. The X-ray may show if there are calcium deposits on the lateral epicondyle at the connection of the extensor tendon. Other special tests such as magnetic resonance imaging (MRI) aren't routinely ordered. The doctor may order additional tests of this type when the diagnosis is not clear. MRI scans use magnetic waves to create pictures of the elbow in slices. The MRI scan shows tendons as well as bones. Ultrasound tests use high-frequency sound waves to generate an image of the tissues below the skin. As the small ultrasound device is rubbed over the sore area, an image appears on a screen. This type of test can sometimes show problems with collagen degeneration. Doctors are also now looking at bone scanning imaging as a possible diagnostic tool for this type of problem. This technique is called bone scintigraphy. Bone scintigraphy looks at the distribution of blood flow and active bone. It helps show blood flow to and through the bone and shows places throughout the skeletal system where the bone is actively metabolizing. The advantage of bone scintigraphy is that changes in bone metabolism show up on the bone scan before structural changes would appear on an X-ray. Conditions such as fractures, infections, tumors, and arthritis can be recognized with a bone scan long before they can be seen with plain radiographs. In the case of epicondylitis, bone scintigraphy can show whether or not there is a reparative process started. The test results don't explain what is causing the problem. They just show the specific areas of bone where local bone responses are occurring. This is not routinely ordered and would not be part of a standard diagnostic examination. Tuomo T. Pienimäki, MD, PhD, et al. Three-Phase Bone Scintigraphy in Chronic Epicondylitis. In Archives of Physical Medicine and Rehabilitation. November 2008. Vol. 89. No. 11. Pp. 2180-2184.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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