Lateral epicondylitis, commonly known as “tennis elbow” is a rather common condition that affects the tendons that arise off the bony prominence on the outside of the elbow, known as the lateral epicondyle. The tendons that come off this area are responsible for allow the wrist and fingers to extend. The most common tendon that is involved is the tendon to the extensor carpi radialis brevis, or ECRB. Overuse of this area causes damage to the tendon and results in pain with wrist movement.
Tennis elbow is a degeneration of the tendon that attaches the wrist extensor muscles to the elbow. A tendon attaches a muscle to bone. In this case, the ECRB is the muscle, and it attaches to the lateral epicondyle. In cases of overuse, the tendon can degenerate, which cause pain in the area. It is particularly painful in patients who must do repeated wrist extension activities.
Repeated wrist extension is very common in those who play tennis and other racquet sports (hence the name tennis elbow), but can occur to many other people as well. It is common in golfers and baseball players, but affects people who must use their wrist a lot on an everyday basis. This includes many professions such as plumbers, gardeners, electricians, and construction workers. It is also becoming more and more common in people who must type as part of their daily work. Although it is most common in people from 40 to 60 years of age, it can affect anyone at any age.
A history and physical exam is usually all that is necessary to diagnose tennis elbow. Patients will describe pain in the outside of the elbow, pain with lifting objects (even as light as a cup of coffee), and pain that radiates down the forearm. There is usually no numbness or tingling associated with tennis elbow.
During the physical exam, the physician usually will try to reproduce pain by pressing directly on this area, or ask the patient to lift the wrist and fingers against resistance. These two simple tests are usually all that is necessary to diagnose tennis elbow.
Radiographs are not routinely obtained, but an MRI is sometimes in order to determine how much tendon degeneration there is. An MRI is typically reserved for those patients who do not get better with non-surgical treatment.
Rest, activity modification:
The first step is to avoid any activities that cause pain to the elbow. This is particularly important in racquet sports, as a break from the activity can allow the tendon time to heal and recover. Ice to the area can be helpful as well. Changing the grip on the racquet in tennis and squash players can be very helpful as well (the grip is often too large). In people who have pain with typing, lowering the keyboard may take some stress off the wrist extensors and alleviate pain.
Performing a simple stretch with the wrist flexed and the elbow straight 3 times daily will often help alleviate symptoms. Some people also benefit from a formal physical therapy program, especially if their symptoms have been going on for a long period of time.
Although not truly an inflammatory process, oral anti-inflammatories such as advil, Aleve, or motrin can help decrease the pain felt from tennis elbow and can be used to help decrease symptoms.
Braces such as a counterforce brace or wrist brace can be used to help decrease symptoms as well. Both of these function by taking the stress off the tendons and allowing time for the tendon to recover and heal.
If the symptoms do not improve with these measures, some physicians advocate a corticosteroid injection into the area.
If these treatments fail to provide adequate relief, surgical treatment is an option. The surgery is performed in an outpatient setting, and involves removing the diseased tendon tissue and reattaching the healthy tendon to bone. After the procedure the arm is splinted until the sutures are removed (usually at 1 week after surgery) and a rehabilitation program is started.
In cases where the symptoms are acute (present for less than 4 weeks), a program as described above can lead to significant improvement after 4 to 6 weeks. In more chronic cases, the symptoms can take longer to disappear (often 3-6 months). In these patients, referral to a physical therapist may be warranted in order to help facilitate recovery. Surgery, although performed rarely for this condition, is usually successful in relieving pain from tennis elbow.