What is tennis elbow?
Tennis elbow, also known as “lateral epicondylitis,” is a common painful and functionally-limiting condition affecting many of our patients. Tennis elbow is caused by degeneration within the extensor carpi radialis brevis (ECRB) tendon on the outside of the elbow. Despite the name, tennis elbow is not just limited to tennis players. In fact, tennis elbow is commonly diagnosed in patients between the ages of 30 and 50, many of whom have never played tennis. We often see this condition in “weekend warriors” and manual laborers.
Patients experience pain on the outside of the elbow and often point to a very tender spot near the lateral epicondyle bony prominence (see image below). Symptoms can be aggravated by a forceful, repetitive activity with the hand and wrist, such as the tennis backhand swing or heavy gripping tasks. Lifting light objects, gripping the steering wheel, and even simple household activities can be very painful at times. Pain can radiate into the forearm and cause weakness in the hand. Fortunately, the majority of patients with tennis elbow improve with non-operative treatment, although symptoms often take several weeks or months to resolve.
What is golfers elbow?
Golfer’s elbow, or “medial epicondylitis,” is a similar condition which causes pain on the medial, or inside, of the elbow. Both tennis elbow and golfers elbow can be diagnosed in the office based on your symptoms, physical exam, and x-rays. MRI is typically not required to make the diagnosis.
What are the non-operative treatment options for tennis elbow?
Braces: Wearing a forearm strap (counterforce brace) or wrist splint
Activity modification: Resting, avoiding repetitive, heavy lifting or forceful gripping
Medications: Taking anti-inflammatory medications such as Motrin, Naproxen, or Tylenol
Stretches: Gently stretching the muscles of the hand, wrist, and elbow with therapy exercises
Hand Therapy: A therapist can guide tennis elbow exercises and perform iontophoresis, ultrasound, or therapy modalities
Corticosteroid injection: Anti-inflammatory medication injection targeting the degenerative ECRB tissue can reduce pain
PRP (platelet rich plasma): injection procedure which has inconclusive results in the scientific literature, not used in our office
Prolotherapy: injection procedure which has inconclusive results in scientific literature, not used in our office
When is surgery recommended?
If non-operative treatment fails to improve the symptoms to a satisfactory degree after several months of conservative treatment, surgery may be recommended. During the outpatient surgery, a small portion of degenerative ECRB tissue is removed or “debrided.” This procedure is thought to stimulate healing of the normal surrounding tissues while removing the painful degenerative tissue. The type and length of incision varies among surgeons. This surgery is not a “quick fix” since returning to sports, heavy work, or weight training can take 3-6 months and additional therapy.
What are the results from surgery?
Most patients experience a significant reduction in pain, report improved function, and are satisfied with their outcome after tennis elbow surgery. However, not all patients experience complete pain relief.
What are the complications from surgery?
No surgery is risk-free. However, major complications from tennis elbow surgery are uncommon. Possible but uncommon complications include persistent pain, infection, stiffness, ligament injury and nerve injury.
For more information, please contact the Raleigh Hand Center at 919-872-3171 to schedule a consultation with a fellowship-trained hand and upper extremity orthopedic specialist. Physical and occupational therapy is also available at Raleigh Hand Center for treatment of tennis elbow, golfer’s elbow, elbow fractures and injuries, and other pain-causing problems of the hand, wrist, elbow, and shoulder. RHC serves patients from the greater Raleigh area, the Research Triangle Park, eastern North Carolina, southern Virginia, and South Carolina. If you have a painful elbow or injury please call our office to schedule a consultation.
The image is copyright American Society for Surgery of the Hand.