Tennis
Elbow (Lateral Epicondylitis)
Tennis elbow is a degenerative condition of the tendon fibers that attach on the bony prominence (epicondyle) on the outside (lateral side) of the elbow. The tendons involved are responsible for anchoring the muscles that extend or lift the wrist and hand.
Chronic
overuse leads to tendon degeneration, which is
painful.
Tennis
elbow happens mostly in patients between 30 years and 50 years of age. It can
occur in any age group.
Tennis
elbow can affect as many as half of athletes in racquet sports. However, most
patients with tennis elbow are not active in racquet sports. Most of the time,
there is not a specific traumatic injury before symptoms start.
Many
individuals with tennis elbow are involved in work or recreational activities
that require repetitive and vigorous use of the forearm muscle. Some common
activities that lead to epicondylitis include:
- Recreational: Tennis (groundstrokes), racquetball, squash, fencing
- Occupational: Meat cutting, plumbing, painting, raking, weaving
Some
patients develop tennis elbow without any specific recognizable activity
leading to symptoms.
Common
activities that lead to epicondylitis are both recreational (tennis, especially
groundstrokes; racquetball; squash; and fencing) and occupational (meat
cutting, plumbing, painting, raking, and weaving).
Patients
often complain of severe, burning pain on the outside part of the elbow. In
most cases, the pain starts in a mild and slow fashion. It gradually worsens
over weeks or months.
The
pain can be made worse by pressing on the outside part of the elbow or by
gripping or lifting objects. Lifting even very light objects (such as a small
book or a cup of coffee) can lead to significant discomfort.
In
more severe cases, pain can occur with simple motion of the elbow joint. Pain
can radiate to the forearm.
The
diagnosis of tennis elbow begins with a complete medical history.
There
will be a full physical examination.
- The sports medicine expert may press directly on the bony prominence on the outside part of the elbow to see if it causes pain.
- The sports medicine expert may also ask you to lift the wrist or fingers against pressure to see if that causes pain.
X-rays
are not necessary. Rarely, magnetic resonance imaging (MRI) scans may be used
to show changes in the tendon at the site of attachment onto the bone.
Nonsurgical
Treatment
In
most cases, nonsurgical treatment is be tried before surgery.
Pain
relief is the main goal in the first phase of treatment.
- You will betold to stop any activities that cause symptoms.
- You may need to apply ice to the outside part of the elbow.
- You may need to take acetaminophen or an anti-inflammatory medication for pain relief.
Orthotics
can help diminish symptoms of tennis elbow. You will use counterforce braces
and wrist splints. These can reduce symptoms by resting the muscles and
tendons.
Left, counterforce brace. Right, wrist brace.
Symptoms
should improve significantly within four weeks to six weeks.
If
symptoms do not improve, the next step is a corticosteroid injection around the
outside of the elbow. This can be very helpful in reducing pain.
Corticosteroids are relatively safe medications. Most of their side effects
(i.e., further degeneration of the tendon and wasting of the fatty tissue below
the skin) occur after multiple injections. Avoid repeated injections (more than
two or three in a specific site).
Wrist stretching exercise with elbow extended.
After pain is relieved, the next phase of treatment starts. Modifying activities can help make sure that symptoms do not come back. The sports medicine specialist will want you to do physical therapy. This may include stretching and range of motion exercises and gradual strengthening of the affected muscles and tendons (see figure right). Physical therapy can help complete recovery and give you back a painless and normally functioning elbow. Nonsurgical treatment is successful in approximately 85 percent to 90 percent of patients with tennis elbow.
Surgical
Treatment
Surgery
is considered only in patients who have incapacitating pain that does not get
better after at least six months of nonsurgical treatment.
The
surgical procedure involves removing diseased tendon tissue and reattaching
normal tendon tissue to bone (figure below). The procedure is an outpatient
surgery, not requiring an overnight stay in the hospital. It can be performed
under regional or general anesthesia.
- Most commonly, the surgery is performed through a small incision over the bony prominence on the outside of the elbow.
- Recently, an arthroscopic surgery method has been developed.
After
surgery, the elbow is placed in a small brace and the patient is sent home.
About one week later, the sutures and splint are removed. Then exercises are
started to stretch the elbow and restore range of motion. Light, gradual
strengthening exercises are started two months after surgery.
The Sports medicine expert will tell you when you can return to athletic activity. This is usually approximately four months to six months after surgery. Tennis elbow surgery is considered successful in approximately 80 percent of patients.