Lateral Epicondylitis (Tennis Elbow)

Lateral epicondylitis, or tennis elbow, is one of the most common sources of elbow pain.  The pain is related to injury of the tendons which attach to the lateral epicondyle bone of the elbow. 

Typically this is a problem related to repetitive overuse of the elbow either due to a particular occupation or sport. Sometimes, however, an acute injury may be the cause of lateral epicondylitis.

 

Diagnosis

Patients with tennis elbow typically have pain and tenderness on the outer aspect of the elbow.  Lifting, carrying, and even hand shaking causes a sharp pain that may radiate down from the elbow to the wrist.

Examination findings include tenderness directly over the lateral epicondyle and pain with resisted wrist extension or forearm supination.  

 

Imaging

The diagnosis of tennis elbow can usually be made solely on examination, but imaging of the elbow may be helpful in particular cases.  MRI or Ultrasound can be used to diagnose lateral epicondylitis and assess the severity of the disease.

 

Non-Operative Treatment

In the majority of cases, lateral epicondylitis will resolve with non-surgical treatments alone.  There are a variety of treatments that have been used to treat lateral epicondylitis which include:

Medication

Over the counter Non-Steroidal Anti-Inflammatories (NSAIDs) and prescription topical anti-inflammatory creams are often part of the first line of treatment.  While the pathology of lateral epicondylitis relates more to scar than inflammation, these medications often have positive responses with patients.

Stretching & Strengthening

Stretching and strengthening exercises can be done at home or with the help of a physical therapist.  These are specific exercises focused on gentle stretching and progressive strengthening of the injured tendons attaching to the lateral epicondyle. 

Bracing

Braces are typically used to unload the areas of stress.  A counterforce brace is placed several finger-breadths below the lateral epicondyle around the forearm and acts to off-load the stresses placed on the elbow. Wrist control splints can also be used. They help limit excessive wrist motion, therefore reducing the pulling stress at the attachment site of these tendons at the elbow.

Corticosteroid or PRP injections

When other options fail to provide relief, an injection of corticosteroid may be considered.  Platelet-rich plasma (PRP) injections have been shown to have some success as well for treating lateral epicondylitis.  Injections at the site of pain can significantly reduce symptoms for up to 3 months, but may not be curative for the disorder when used alone without other treatments like bracing and exercises. 

 

Operative Treatment

When non-operative treatment fails, surgical treatment can be considered.  There are three methods of surgical treatment for tennis elbow:

    - Open Surgery

    - Arthroscopic Surgery

    - Percutaneous Tendon Release

If surgery is indicated, your surgeon will discuss with you the advantages and disadvantages of each technique depending on your specific symptoms as well as your individual demands, occupation, and recreational activities.

 

 

 

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