Tennis Elbow – It Doesn’t Only Happen to Tennis Players
By: Brian Lee, MD
When it comes to the conditions that can affect the elbow, there are many, and you can’t judge them all by their popular names. Tennis elbow is one such orthopaedic injury that can happen to just about anyone, whether or not they play tennis. In this article, we’ll explore what causes lateral epicondylitis, how it got it’s commonly referred to name “tennis elbow,” and the symptoms associated with it.
Tennis elbow, or lateral epicondylitis, is a degenerative, inflammatory condition of the extensor carpi radialis brevis muscle origin. It is thought to happen as a result of overuse of the extensor muscles, which are responsible for providing wrist and finger extension. Since about everyone uses these muscles a considerable amount throughout the day, it’s probably no surprise that many of the people who develop tennis elbow don’t play tennis! The muscle is an interesting one in that its origin is tendon-like, and examination of it under a microscope in patients with lateral epicondylitis demonstrates abnormal tissue. It is most commonly characterized by tenderness at the lateral epicondyle portion of the elbow, pain when extending the wrist and fingers and, often, decreased grip strength.
While pain at the lateral epicondyle, on the outside of the elbow, is most commonly lateral epicondylitis, other situations can cause pain in that area. Careful examination by a skilled physician is required to ensure a patient is not actually having symptoms from arthritis of the elbow, radial tunnel syndrome (compression of a nerve at the elbow), biceps tendonitis, or a rupture of the extensor wad itself.
The good news is that the vast majority of patients recover from tennis elbow without surgery. I recommend physical therapy for a multi-faceted treatment regimen that includes both icing and heating, anti-inflammatory measures, stretching, and eventual muscle stimulation and strengthening including both eccentric and concentric strengthening exercises. I consider this protocol to be the mainstay of treatment, and it works by not only first helping the inflammation to subside but eventually retraining and strengthening the muscles of the extensor wad so that it can subsequently function normally again. Anti-inflammatory medications, both taken by mouth and applied topically can be helpful, and many patients find a tennis elbow/counterforce brace, which diminishes the tension on the wrist extensors to reduce symptoms as well. Similarly, Kinesio-taping (KT) and other myofascial release techniques can be helpful.
While the traditional treatment for tennis elbow has included steroid injections, I hesitate to utilize that as a first-line treatment measure as there is evidence that it is not superior to other options and may have detrimental effects on the tendons of the elbow. Newer treatment modalities include shock wave therapy, platelet-rich plasma, and stem cell injections, which through a variety of mechanisms, aim to create a healing response in the injured elbow tissue. There is currently no standard as to which treatment is best, and we continue to study the various treatment options for patients.
No matter the conservative treatment approach, it is essential to know that tennis elbow takes time to resolve, not uncommonly up to 12 months for full relief. Rehabilitation from this condition is more of a marathon than a sprint to get better. With that in mind, I encourage patients to take a less-invasive to progressively more invasive approach. If tennis elbow does not improve with physical therapy, bracing and anti-inflammatory medication, a discussion regarding injections or a minimally invasive procedure is in order. However, surgical intervention, though effective, is reserved for patients whose condition fails to improve with conservative measures.
Surgical intervention for tennis elbow can be performed via an incision and meticulous examination of the tendon. Depending on the degree of tendon degeneration and surgeon preference, the procedure involves cleaning out or “debriding” the degenerative tissue, and potentially placing an anchor into the bone with suture passed around the residual tendon to aid in repairing the tissue. Arthroscopic surgery is also an option and has demonstrated excellent results while avoiding the larger incision required for a traditional open approach. Finally, percutaneous techniques to perform a debridement of the tendon have been developed with encouraging results.
Regardless of the cause of or treatment options for lateral epicondyle, it is crucial to have any unresolved pain in the elbow (or anywhere in the body, really) evaluated promptly and by a qualified medical professional. Continuing to “play through” pain or using injured muscles/tendons can result in making the problem worse. More severe injuries of this nature take even longer to heal and may require more invasive intervention to repair. Though you can’t control the injury itself or the time your body will take to recover, paying a visit to the doctor and heeding his or her recommendations are some of the best things you can do to help put yourself on the road to recovery from tennis elbow.