Tennis elbow is an inflammatory tendon condition of localized pain over the outer aspect of the elbow. It is referred to medically as lateral epicondylitis. The pain is also located over the lateral aspect of the joint where the forearm bone (radius) and upper arm bone (humerus) join together.
It is felt that tennis elbow is caused by repeated low level stress on the tendons that connect to the outer aspects of the lower humerus. These muscles connected to these tendons are known as the forearm muscles, which are responsible for extending or bending back of the wrist and fingers. It is thought, when there is too much stress placed on these muscles small mircotears can occur in the tendons, especially at the attachment to the bone.
The pain can be present with almost any activity that is done with the palm downward.
How is the diagnose made?
There are no special tests required to make this diagnosis. It is usually made by history and physical examination. X- rays are frequently normal even though the person may have a definite case of tennis elbow.
How is tennis elbow treated?
Rest in itself does not necessarily cure the problem although it may decrease the painful aspect. With use of the elbow pain returns. Stretching and strengthening exercises are frequently helpful. The following simple exercise is sometimes helpful. With the forearm supported on a flat surface, such as table, and the wrist and hand free, hold a one or two pound weight in hand. Keeping the palm down slowly bring the hand up, thereby extending the wrist. Then slowly bend the hand down. The muscles on top of the forearm will be contracting when the wrist is moved upward and stretched when the hand is moving down. These exercises should be repeated with the palm facing up.
Sometimes a strap is worn around the upper forearm decreasing the pull of muscles and thereby lessening pain in the elbow. The band is usually worn during waking hours and especially while working.
Physicians sometimes prescribe physical therapy treatment for stubborn cases of tennis elbow.
Medications such as Aspirin, Ibuprofen, and a number of prescription anti-inflammatory medications can be helpful to decrease inflammation, but if there is decreased circulation in the area these oral medications may not provide enough medication to the affected area to alter symptoms.
Ice is frequently used to decrease inflammation and relieve pain.
Injection of the painful area with a Cortisone - like medication is still used on occasion, but not as frequently as in the past.
In conditions where no treatment has been helpful and the problem has become disabling, a surgical procedure is sometimes suggested which can be very helpful in eliminating the problem of tennis elbow.
It should be pointed out that cases of tennis elbow (lateral epicondylitis) may take many months for the condition to resolve whether the treatment is non-surgical or surgical. If the condition has resulted from activities in the patient's work place, ergonomic evaluation is essential to assist the worker. Avoidance of activity patterns that require overhand gripping and pulling can decrease the incidence of this injury significantly.
There have been several operations that have been done to try to relieve the pain of tennis elbow, but perhaps the most common is a procedure in which the attachment of the extensor tendons to the lateral aspect of the elbow or lateral epicondyle is released and a small portion of the bone underneath is removed.
The upper extremity needs to be immobilized in a long arm splint for at least two to four weeks and then gentle range of motion exercise is begun.
Surgery is usually done as an outpatient and general anesthesia would be a common form of anesthesia for this condition.
While it can take an extended period of time for the elbow to heal, it usually will heal and symptoms will markedly diminish. I have very rarely seen the recurrence of tennis elbow following surgery if the patient has initially gotten a good result.
The discomfort that the patient does have in the early months following surgery often can be related more to the de-conditioned extensor muscles in the forearm.
Perhaps the very low rate of recurrence is due to the combination of successful therapy following surgery and ergonomic changes in the work place or at home.
It has been noted that some of the most successful surgical results are in patients who have initially responded to a cortisone-like injection in the elbow, but then had a recurrence of symptoms at some point following the injection.
Tennis elbow or lateral epicondylitis is the most common affliction of the elbow that we treat. It's cousin, medial epicondylitis, which has occasionally been referred to as golfer's elbow is very similar to its lateral counterpart, but is much less common and non-surgical treatment is almost always effective.