Tennis Elbow Diagnosis

Tennis elbow is typically diagnosed by a physical exam, though diagnostic imaging may be administered to rule out other types of elbow or forearm injuries that produce similar symptoms, such as a bone chip/fractured elbow, arthritis, stress fracture(s) of the forearm or upper arm, or nerve entrapment(s).¹Kurppa K et al. Tennis elbow: lateral elbow pain syndrome. Scand J Work Environ & Health 5 (1979); suppl. 3, 15-18.^,2Reynolds, G. Phys ed: an easy fix for tennis elbow? August 25, 2009: The New York Times, WELL Blog. http://well.blogs.nytimes.com/2009/08/25/phys-ed-an-easy-fix-for-tennis-elbow/?_r=0. Accessed December 29, 2014.

Patients often see their primary care doctor first for suspected tennis elbow, and the primary care doctor can often provide treatment. In difficult cases, the primary care doctor may make a referral to another practitioner, such as a physical therapist or orthopedic surgeon trained in sports medicine.³Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med 4 (1992); 11: 851-70. http://www.ncbi.nlm.nih.gov/pubmed/14560549. Abstract accessed December 30, 2014.

Diagnostic process for tennis elbow

Most physicians can diagnose tennis elbow with a physical exam and patient history, and diagnostic imaging may be ordered if the patient's symptoms are somewhat ambiguous, and/or the doctor suspects there may be other concurrent injuries to the elbow or forearm.

Detailed patient history. The patient's doctor takes a complete patient history, including information such as the types of sport(s) and/or occupation and other potential risk factors of the patient, when the symptoms first appeared, and when and where the symptoms are most bothersome. The doctor will also ask the patient about any patient or family history of rheumatoid arthritis or neurological disorders, as these issues can sometimes also cause pain in the elbows and forearms.⁴American Academy of Orthopedic Surgeons. Tennis elbow (lateral epicondylitis). September 2009: OrthoInfo. http://orthoinfo.aaos.org/topic.cfm?topic=a00068. Accessed December 30, 2014. The doctor will also likely ask about any recent medications patients may have taken, because some medications can increase the chances of developing tennis elbow and other injuries to the tendons. Finally, the doctor will ask about specific characteristics of the pain, such as the location of pain, radiation of pain, and numbness or tingling in the fingers.

Physical exam. During the physical exam, the doctor will visually inspect and touch the patient's elbow and arm—and possibly other joints in the body, depending on what diagnosis he or she suspects. Generally, lateral epicondylitis is suspected when the doctor pushes on the lateral epicondyle (or bump on the outside of your elbow) and your pain is reproduced. The doctor may test nerve reflexes with a hammer, and will also inspect bone and joint alignment. The patient's skin may be inspected for signs of rheumatoid or psoriatic arthritis, and blood may be taken to check for signs of these or other autoimmune disorders.⁵Walrod, BJ. Lateral epicondylitis clinical presentation. June 13, 2014: Medscape. http://emedicine.medscape.com/article/96969-clinical#showall. Accessed December 29, 2014. The doctor may also ask patients to hold their affected arm out straight and then press their hand and fingers back to see if this causes pain,³Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med 4 (1992); 11: 851-70. http://www.ncbi.nlm.nih.gov/pubmed/14560549. Abstract accessed December 30, 2014. and may also test the elbow and arm's range of motion to rule out joint damage or nerve entrapments.⁶Almekinders, L, and Matava, M. Tennis elbow. Sports Tips. Rosemont, IL: American Orthopedic Society for Sports Medicine, 2008.

Diagnostic imaging. While tennis elbow usually does not require diagnostic imaging, additional scan tests may be ordered to rule out other possible causes of the patient's symptoms. For example:

• X-rays. While tennis elbow will not show up in X-rays, they can be used to detect other conditions, such as bone fractures, joint misalignment, or one or more types of arthritis.⁴American Academy of Orthopedic Surgeons. Tennis elbow (lateral epicondylitis). September 2009: OrthoInfo. http://orthoinfo.aaos.org/topic.cfm?topic=a00068. Accessed December 30, 2014.^,5Walrod, BJ. Lateral epicondylitis clinical presentation. June 13, 2014: Medscape. http://emedicine.medscape.com/article/96969-clinical#showall. Accessed December 29, 2014.
• Magnetic resonance imaging (MRI). Some cases of elbow and forearm pain and tingling are actually caused by a herniated disc and/or arthritis in the neck, so doctors may perform an MRI scan to rule out these conditions.⁴American Academy of Orthopedic Surgeons. Tennis elbow (lateral epicondylitis). September 2009: OrthoInfo. http://orthoinfo.aaos.org/topic.cfm?topic=a00068. Accessed December 30, 2014.^,5Walrod, BJ. Lateral epicondylitis clinical presentation. June 13, 2014: Medscape. http://emedicine.medscape.com/article/96969-clinical#showall. Accessed December 29, 2014. An MRI of the elbow may show partial tears in the extensor tendon and may help rule out other problems in the elbow, such as cartilage injuries or ligament tears.
• Electromyography (EMG). If the doctor suspects that the patient's elbow symptoms are caused by nerve compression/entrapments in the elbow or elsewhere, this test may be ordered to test nerve conduction in the area.⁴American Academy of Orthopedic Surgeons. Tennis elbow (lateral epicondylitis). September 2009: OrthoInfo. http://orthoinfo.aaos.org/topic.cfm?topic=a00068. Accessed December 30, 2014.
• Power Doppler ultrasound. This type of ultrasound is an emerging diagnostic imaging test for tennis elbow and other types of tendon problems, and it may be used to diagnose or rule out tennis elbow.⁵Walrod, BJ. Lateral epicondylitis clinical presentation. June 13, 2014: Medscape. http://emedicine.medscape.com/article/96969-clinical#showall. Accessed December 29, 2014.^,7du Toit C et al. Diagnostic accuracy of power Doppler ultrasound in patients with chronic tennis elbow. Br J Sports Med 43 (2008); 872-876. doi: 10.1136/bjsm.2007.043901.

Once tennis elbow has been diagnosed, an appropriate treatment plan can begin.