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Tennis Elbow (Lateral Epicondylitis)

WHAT IS TENNIS ELBOW?

 

Tennis elbow, also known as lateral epicondylitis, is an inflammation around the bony knob on the outer side of the elbow.  It occurs when the tissue that attaches muscle to the bone becomes inflamed or irritated.  The bony knob is called the lateral epicondyle.

 

WHAT ARE THE CAUSES?

 

Overuse - A variety of  racket sports or activities such as twisting a screwdriver or lifting heavy objects with your palm down can cause tennis elbow.  Anything that involves extending your wrist or rotating your forearm.  Overuse or any non-work and work related activities that places stress on the tendon attachments, through stress on the extensor muscle-tendon unit, increases the strain on the tendon.  Stress can be caused by “repetitive” gripping and grasping activities,  i.e. meat-cutting, plumbing, painting, weaving, etc.

 

Trauma – A sudden extreme action, force, or activity could injure the tendon as well as a direct blow to the elbow resulting in swelling of the tendon that can lead to degeneration.

 

SIGNS AND SYMPTOMS

 

The primary reason people seek medical evaluation is pain that usually starts at the outer-side of the elbow and tends to travel down the forearm to the hand.  You may experience pain all the time or only `when you lift things.  Another symptom is swelling of the elbow along with redness & feeling warm to the touch.  It may also hurt to grip things, turn your hand, or swing your arm.  Occasionally, any motion

of the elbow can be painful.

 

TREATMENT

 

Conservative (non-surgical)

 

Activity modification -  To begin with, activities causing the condition should be limited.  That doesn't mean you have to have total rest, however, by limiting the activity or modifying grips or techniques, such as use of a different size racket and/or use of 2-handed backhands in tennis, you may relieve the problem.

 

Medication –  Anti-inflammatory medications may help to alleviate the pain

 

Brace – A tennis elbow brace, a band worn over the muscle of the forearm just below the elbow, can allow it to heal by reducing the tension on the tendon.

 

Physical Therapy  which provides stretching and/or strengthening exercises may be helpful as well as

ultrasound or heat treatments.

 

Steroid injections – A strong anti-inflammatory medication such as a steroid can be injected into the area, however, no more than 3 injections should be given.

 

PRP Treatment - This is the use of platelet rich plasma (PRP), to promote healing of injured tendons, ligaments, muscles, and joints.  This treatment can also be applied to various musculoskeletal problems.  Because platelet activation plays a key role in the process of wound and soft tissue healing, this can be a very effective treatment. With PRP Treatment, a portion of the patient’s own blood, which has been enriched with a platelet concentration above baseline, is used to promote healing. 

 

Surgery

 

Surgery should only be considered when pain is incapacitating and has not responded to conservative care, and symptoms have lasted for more than six months.  Surgery involves removing the diseased, degenerated tendon tissue.  There are two surgical approaches available;  traditional open surgery (incision), and arthroscopy – a procedure performed with instruments inserted into the join through small incisions.  Both options are performed in the outpatient setting.

 

Recovery

 

Physical therapy to regain motion of the arm is part of the recovery process.  A strengthening program will be necessary in order to return to prior activities.  You can expect recovery to take 4-6 months.