Friday, April 3, 2009

Pathology of the Tennis Elbow

Etiology- “cause of disease”
Tennis elbow is caused by chronic stress on tissues of the forearm extensor muscles attaching to the elbow. Many different causes include:

  • improper backhand stroke

  • weak shoulder and wrist muscles

  • using a too tightly strung or too short tennis racket

  • hitting the ball off centre on the racket or hitting heavy, wet balls

  • overuse of hand tools

  • heavy lifting

  • occupations that require strenuous or repetitive forearm movement

Also known as Lateral epicondylitis, tennis elbow is extremely common in today's active society. (Medscape, 2009).

Pathogenesis – “what happens from that disease?”
Sandy Fritz explains that pain and tenderness to the elbow is felt when gripping or rotating the wrist and forearms which is common at the start. Stress is then created at the muscle origin which evidently causes microscopic tears that lead to the inflammation of several structures of the elbow including muscles, tendons, bursa, and periosteum. Pain is felt when gripping or rotating the wrist and forearm.

Morphological / Histological – “Changes within the tissues”
The early Morphological and Histological damage consists of small tears in the connective tissue that hold the extensor muscles to the bone, tissue become prone to repeated tearing and become irritated which causes inflammation and swelling. The consequential pressure is capable of cutting off the blood flow and even pinching the radial nerve that controls the arm and hand.

The annual incidence of tennis elbow in general practice is 4-7 cases per 1000 patients, with a peak in patients 35-54 years of age. The peak incidence is between 40 and 50 years of age. (Tidy, 2007).
The risk of overuse injury is increased 2-3 times in players who play more than 2 hours per week and 2-4 times in players older than 40 years. (Medscape, 1994 – 2009)

Prevalence Roetert (1995) noted lateral epicondylitis effects 40-50% of recreational tennis players.


Medscape (1994 – 2009). Etiology of Tennis Elbow. Retrieved March 29th 2009 from

Premkumar,K. (2000).Pathology A to Z- a Handbook for massage Therapists.(2nd edition). Canada; VanPub Books.

Roetert, E. (1995). The biomechanics of tennis elbow: An integrated approach. Clinics in Sports Medicine vol 14 pg 47-57.

Tidy, Dr C. (2007). Epidemiology of the tennis elbow. Retrieved March 30th 2009 from