This all too predictable response then requires me to explain that tennis elbow is in fact a tendonitis of the extensor muscles of the hand and wrist. It can develop from many activities involving lifting objects with one's palm facing down. For example, reaching over the front seat of your car to fetch a briefcase from the floor of the back seat is classic injury producing. The briefcase is simply too heavy to be grasped in this manner because, due to your body position, you get very little leverage from your shoulder muscles, and are forced to rely almost exclusively on the outside or extensor muscles of your elbow to do the work. This excessive pressure can cause a partial tearing of the tendinous insertions on the outside of the elbow. Most people do have these minor tears; just as so many of us have them in our shoulder muscles (rotator cuff tendonitis).
What makes one person's elbow sore, inflamed and painful, and others not, is either repetition of the stress, or lack of proper healing of the tendon, or a condition of increased tension in the extensor muscles. This latter condition of underlying tightness in the muscle delays healing by causing an aberrant and constant traction on the tear, thereby, not allowing proper healing to occur. Much like a cut is slow to heal if one continually separates the skin borders. In this case, as in the case of repetitive stress, you get partial healing, followed by partial tearing, followed by partial healing, etc. as the cycle goes on with the activities of daily life. The end-result is a scar that is jagged, uneven and one that has 'tight' sections and 'loose' sections.
A scar that has developed in this manner will cause pain and inflammation each time the muscle is used. At this point the patient complains that s/he cannot even pick up a cup of coffee or open a door without pain.
