Tennis elbow, or lateral epicondylitis, is one of the most common elbow problems seen by an orthopedic surgeon.
It is actually a tendonitis (medically spelled tendinitis) of the muscle called the extensor carpi radialis brevis, which attaches to the lateral epicondyle of the humerus. It may be caused by a sudden injury or by repetitive use of the arm.
Many doctors feel that micro tears in the tendon lead to a hypervascular phenomenon resulting in pain. The pain is usually worse with strong gripping with the elbow in an extended position, as in a tennis backhand stroke, but this problem can occur in golf and other sports as well as with repetitive use of tools.
Before surgery is considered, a trial of at least six months of conservative treatment is indicated and may consist of a properly placed forearm brace and a combination of elbow activity modification, anti-inflammatory medication, and physical therapy. If the above treatment is not helpful, a cortisone injection can be beneficial, but no more than three injections are recommended in any one location in a year.
Conservative treatment is in two phases, and after Phase I (pain relief) has been successful, Phase II (prevention of recurrence) is equally important and involves stretching and later, strengthening exercises, so the micro tears will not occur in the future.
When conservative treatment has failed, then surgery is indicated. Many procedures have been described. Procedures as simple as percutaneous release of the tendon off of the bone have been described and more recently, arthroscopic procedures or other procedures involving the joint and resection of a ligament as well have been described.
The most popular procedure today is a simple excision of diseased tissue from within the tendon, shaving down the bone, and re-attachment of the tendon. This can be performed as an outpatient procedure with regional anesthesia (where only the arm goes to sleep), and through a relatively small incision of approximately three inches. Eighty-five to ninety percent of patients who undergo this procedure are typically able to perform full activities without pain after a recuperation of two to three months. Approximately 10-12% of patients have improvement, but with some pain during aggressive activities, and only 2-3% of patients have no improvement.
This condition, commonly called tennis elbow, is an inflammation of the tendons that connect the muscles of the forearm to the elbow. The pain is primarily felt at the lateral epicondyle, the bony bump on the outer side of the elbow.
The elbow joint is a complex group of bones, muscles, ligaments and tendons. Lateral epicondylitis involves the extensor muscles, which control the extension of the wrist and fingers, and the extensor tendons, which anchor the muscles to the lateral epicondyle.
Lateral epicondylitis is caused by specific repetitive motions of the wrist and arm. The stress placed on the forearm by a tennis backstroke is a common culprit. This stress causes tiny tears to develop in one or more extensor tendons. This results in inflammation and pain.
This condition typically causes pain and tenderness that is centered on the lateral epicondyle. This pain may radiate along the forearm and wrist. The grip of the hand may feel weak.
Lateral epicondylitis typically affects people between the ages of 30 and 50. It is a common complaint of athletes who play racquet sports, but certain occupations can also raise a person’s risk. This condition is common among plumbers, painters, carpenters and butchers.
Treatment options may include rest, ice, antiinflammatory medications and stretching exercises. A physician may recommend an arm brace or wrist splint and physical therapy or massage therapy. Steroid injections or PRP injections may also provide relief.
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