Tennis elbow, more formally known as lateral epicondylitis, is a very common condition. It is a degenerative tendonosis, meaning that a specific group of tendons starts to wear as a result of repetitive use. This repetitive use results from normal daily activities in most cases, but may be aggravated by the activities of some jobs or some avocations. It may occasionally be brought on by a single direct injury to the area. Playing tennis itself can be an aggravating factor, but tennis players make up only a small percentage of individuals who develop tennis elbow.

Why someone develops tennis elbow is most probably a combination of factors: what they do, how they do it, and their individual anatomy. Repetitive wrist motion, gripping, and lifting activities are most often implicated. Pain is the predominant feature of this condition, and is generally made worse with activity. It is located on the outside, or lateral, aspect of the elbow, but can radiate up or down the arm. This condition is not associated with numbness or tingling.

The process usually starts with small, microscopic tears in the tendons as they originate off the bone of the lateral epicondyle. These tears may progress and degeneration of the tendon may occur. There is edema and bleeding in the area, and an inflammatory swelling in the joint lining deep to the tendons, called synovitis may be associated. Eventually, scar tissue forms. Treatment is directed to decrease pain and stop the cycle of repeated tendon wear.

Conservative measures are usually employed first. The include the following measures:

1. Wear of a forearm strap. This device, also called a counterforce brace, is designed to change the site of muscle tension from the bone of the lateral epicondyle to an area over the muscle just below it. It has been shown by intricate electrical studies to actually accomplish that transfer. It reduces symptoms in all most patients, and is worn primarily when active. This may be while the individual is at work, sport, or engaged in home activities that require frequent gripping, grasping, or wrist motion. The strap should be positioned correctly and not worn too tightly.
   
   
2. Wear of a wrist splint. This may be worn with or without the forearm strap. It decreases use of the extensor tendons to the wrist, which are the tendons found to have degenerative changes. It is also used primarily for activities.
   
   
3. The use of ice. Ice or cold packs can greatly reduce the amount of inflammatory response, and should be applied to the lateral epicondylar area for 5 to 10 minutes. It is most effective immediately after work, sport or other activities that utilize the involved tendons.
   
   
4. The use of moist heat. Heat may be effective when used either before activity or well after the activity.
   
   
5. Anti-inflammatory medications may be of some benefit. There are many available, including Advil, ibuprofen, and Motrin. All medications have possible side effects, including anti-inflammatory medications. The most common side effect is irritation of the stomach, even leading up to ulcers. Whenever possible, these medications should be taken for short, specified time periods, and with milk or food. Prescription anti-inflammatory medications are more expensive, but may be less irritating to the stomach and can usually be taken on a less frequent basis such as once or twice a day. Other medical conditions, such as the need to take blood thinners, may prohibit the use of these medicines. Check with your doctor to make sure.
   
   
6. Lifting modifications. Lifting with the palm down utilizes the tendons involved in this condition. If some lifting can be switched to palm up, a different group of tendons will be utilized. Other activity modifications may be possible. Grip and racquet changes in racquet sports may help, use of alternate tools, and more frequent rotation of job activities can all be helpful factors. Lifestyle changes – changes in the way work or activities are conducted, may be the most important aspect of treating this condition. Repetitive wrist motion activities should be avoided.

These measures supply adequate relief for the majority of patients. If they are not adequate, other options are available to include supervised therapy, cortisone injection, casting, or blood injections. Other conservative measures, as listed above, should be employed in conjunction with these options:

CORTISONE INJECTION: Cortisone injections are given to reduce inflammation and pain. This is a temporary measure that decreases symptoms while the body is in the process of healing. Up to three cortisone injections can be given. The risks of cortisone shot include a small risk of infection, a small risk of allergic reaction, weakening of a tendon, and a small risk of soft tissue atrophy (a depression in the tissue with whitening of a patch of skin) adjacent to the injection.

SUPERVISED THERAPY:A therapist can be beneficial by teaching stretching and eventual strengthening exercises, and in teaching alternative ways to accomplish activities. A therapist can also employ modalities such as electrical stimulation, ultrasound, or a different way of administering cortisone (iontophoresis,) that may decrease pain.

CASTING: Applying a cast for 4 weeks to fully immobilize the elbow is a rarely employed alternative. It enforces rest to allow the elbow a head start toward healing. Once removed, the conservative measures described above must be employed.

AUTOLOGOUS BLOOD INJECTION: Recent studies have shown pain relief in many patients when a small amount of their own blood is withdrawn from a vein, and then injected into the painful tendon area with a mixture of local anesthetic. Our results have shown good pain relief after 1 to 2 weeks in many patients, although not for everyone.

Many other interventions have been tried, including acupuncture. Acupuncture has provided relief in some, but not all, patients. Cold laser therapy and extracorporeal shock therapy remain unproven, and are not used in our office

MEDIAL EPICONDYLITIS: A similar degenerative tendonitis can occur on the medial, or inside, aspect of the elbow. This is sometimes called golfer’s elbow. This condition occurs much less commonly than tennis elbow, but the treatment measures differ in only small ways: the forearm strap is worn so that the pad is on the medial aspect of the forearm, and lifting modifications include trying to lift with the palm down instead of up. All other measures as listed for tennis elbow are identical. As with tennis elbow, most patients eventually resolve the problem without the need for surgery.

updated DEC 2008

Contact Our Office with any Questions or Comments
Copyright © 2000-2008 Cedar Valley Hand Surgery
Please see our Disclaimer