Lateral epicondylitis, commonly known as tennis elbow, is a painful condition involving the tendons that attach to the bone on the outside (lateral) part of the elbow. The muscle involved in this condition, the extensor carpi radialis brevis, helps to extend and stabilize the wrist. With lateral epicondylitis, there is degeneration of the tendon’s attachment, weakening the anchor site and placing greater stress on the area. Sports such as tennis can be associated with this, but the problem can occur with many different activities whether it be athletic, or otherwise. The most common group that this condition affects are people between the ages of 30 to 50 years old, but it may also occur in younger and older age groups as well. Tennis elbow affects both men and women.
Sometimes the tendon on the outside of the arm degenerates over time with no direct cause. In other cases, activities that place stress on the tendon attachments of the extensor muscle-tendon unit increases the strain on the tendon. These stresses can be from holding a racquet grip or from other “repetitive” gripping and grasping activities, such as plumbing, painting, lifting weights, etc.
Signs and Symptoms
Pain is the primary reason for patients to seek medical evaluation. The pain is located on the outside of the elbow, over the bone known as the lateral epicondyle. This area becomes tender and painful with activities which stress the tendon, such as gripping or lifting. The pain usually begins at the elbow and may travel down the forearm. Occasionally, any motion of the elbow can be painful.
Activity modification: Initially, the activity causing the condition should be limited. Avoiding lifting objects away from the body with the palm down and remembering to lift items close to the body in the palm up position can help prevent stress on the extensor tendons.
Medication: Anti-inflammatory medications (e.g. Advil®, ibuprofen) may be taken to help alleviate the pain.
Brace: There are two main braces used for this condition. (1) A tennis elbow or “counterforce” brace is a band worn just below the elbow that can reduce the tension on the tendon. Make sure you place the “bump” on the outer part of the elbow. (2) A wrist splint that allows the extensor tendons to rest.
Physical Therapy: Stretching and/or strengthening exercises combined with modalities such as ultrasound or heat treatments may be helpful.
Steroid injections: A steroid is a strong anti-inflammatory medication that can be injected into the area. As cortisone may weaken tendons, this should be discussed with your surgeon.
Platelet Rich Plasma (PRP): PRP is a treatment in which blood is drawn from a patient and spun in a centrifuge to isolate the portion of the blood rich in platelets and the body’s own healing factors. This concentrated portion of platelets and healing factors are then reinjected specifically into the degenerated area of the tendon to speed up the body’s own healing response. PRP has been used among professional athletes for many years and its use in patients has become a popular method to boost the body’s natural healing process.
Office-based Percutaneous Tenotomy: Office-based percutaneous release for lateral epicondylitis is a viable option that may be considered for the treatment of this disease. It provides a simple and minimally invasive method that can be performed quickly, wide-awake using only local anesthesia, and with minimal equipment.
Surgery: Surgery is only considered when the pain is incapacitating, the condition has not responded to conservative care, and symptoms have lasted more than 1 year. Surgery may be performed open (with an incision) or arthroscopically (with instruments inserted into the joint through smaller incisions). Both options are performed in the outpatient setting. Recovery from surgery can be expected to take from four (4) to six (6) months and may require physical therapy.