Tennis Elbow or Lateral Epicondylitis

Tennis Elbow is one of the most commonly seen overuse conditions in Orthopaedics, although it is not necessarily related to playing tennis. Any repetitive activity that puts strain on the tendons which join the forearm muscles to bone can cause this painful problem. Carpenters, cooks, plumbers, painters and butchers tend to get this condition more often than the general population, but sometimes people can develop the problem without any known repetitive work or activity. People who get it tend to be in the 30-50 year old range, but it can strike at any age. In this article, I will discuss this common problem and how it is best treated and prevented.

Symptoms

When Tennis Elbow begins, simple activities, such as shaking hands, grasping objects, lifting, and opening doors becomes painful. Touching the outside boney part of the elbow on a desk or hard surface can hurt. It can ache without any activity at all and worsen with activity. You may notice that you can’t grip things as tightly or doing so causes pain. Your pain probably started gradually and worsened over time, although in some cases, it can come on forcefully.

At Home Treatment

The best thing to do is to rest the tendon and the forearm muscles to allow for healing. Try Aleve or Ibuprofen for pain and to relieve inflammation. Try icing the outside of the elbow intermittently for 15 minutes several times a day. If you do these three things regularly for one week and do not see improvement, you should make an appointment with an OSC Orthopaedic Specialist.

Conservative Treatment

When you make an appointment at OSC, x-rays will be ordered to make sure there isn’t anything else going on with your elbow joint, like arthritis. You will have a complete examination and be asked to move your arm and do physical tests to ascertain what movements cause pain. Most patients respond extremely well to a steroid injection and a simple elbow brace. Physical Therapy may also be recommended strengthen your forearm muscles with gentle exercise. The therapist may also perform specific modalities which use gentle electric current to promote healing of the tendon or a laser that increases blood flow to the area to encourage healing.

An MRI study may be ordered for cases that do not respond well to see if there are micro-tears in the tendon or if there is something else going on with the elbow. Steroid injections can be repeated if necessary.

For more stubborn cases, we can also try an injection of Platelet Rich Plasma (PRP) which is derived from the patient’s own blood and spun in a centrifuge. This treatment is very popular with professional athletes and has shown success in treating difficult cases of tennis elbow. This uses the body’s own healing power to stimulate tissue growth and regeneration; however, it is not covered by insurance.

Surgical Treatment

Unfortunately, there are some cases of Tennis Elbow which do not respond to conservative treatment. After 6 months to a year of unsuccessful treatment, a patient may wish to consider surgical options available to relieve the pain and dysfunction.

We are able to surgically repair the tendon easily in an outpatient procedure which is a tendon release surgery. During the procedure, the tendon is released from the bone, the damaged part of the tendon is removed and the bone is made to bleed before reattaching the now healthy tendon. The bleeding bone helps to heal the reattached tendon. We can do this arthroscopically, through small incisions, with minimal bleeding and trauma to the patient or in an open surgery, or with a standard incision.

Post-operatively, the patient will be in a splint for about a week. After the sutures are removed, the patient will begin Physical Therapy to regain strength and range of motion. A full return to activities will take 4 to 6 months.

Prevention

It is better to never get Tennis Elbow than to try and heal it. You can do this by strengthening the muscles in the forearm with gentle exercise. You can do this by simply holding very light weights and flexing your wrists up and down (forearm curls ). If you play a sport, it would be a great idea to consult with a sports professional to learn the proper form for your sport with regard to your forearm.

If you do repetitive work, consider changing your workstation to be more ergonomically friendly. Consult with your employer about ways to more safely do your job with less stress on your body, especially the muscles in your forearms. Most employers are happy to help employees that are engaged, productive and who want to stay that way.