Evaluation of Sleep Position for Possible Nightly Aggravation and Delay of Healing in Tennis Elbow

J Am Acad Orthop Surg Glob Res Rev. 2019 Aug 2;3(8):e082. doi: 10.5435/JAAOSGlobal-D-19-00082. eCollection 2019 Aug.


Tennis elbow symptoms are reportedly most severe in the morning, which prompted a search for a pathological process while asleep. A "pathological sleep position" was hypothesized that repetitively aggravates an elbow lesion if the arm is overhead and pressure is on the lateral elbow. This hypothesis was tested by using a restraint to keep the arm down while asleep.

Methods: This study was a retrospective review. All patients were advised to use a restraint to keep the arm down at night. The presence of the restraint in the morning was correlated with the subjective report. The control group consisted of the noncompliant patients.

Results: Compliance and subjective improvement was documented in 33 of 39 patients (85%). Subjective improvement was reported by 66% of the compliant patients after 1 month. Pain continued after the first 3 months only in 6 of 39 noncompliant patients (15%).

Discussion: In this pilot study, patients who kept the arm down at night improved, whereas patients who were noncompliant continued to be symptomatic. Sleep position should be considered as a possible aggravating factor that delays healing of an acute injury and results in chronic pain. If validated, keeping the arm down at night can be recommended for tennis elbow.