Tennis elbow or lateral epicondylitis is a painful condition involving the tendons that attach to the bone on the outside (lateral) part of the elbow. The muscles involved in this condition help to straighten and stabilize the wrist.
With tennis elbow, there is degeneration of the tendon’s attachment, weakening the anchor site and placing greater stress on the area. This can lead to pain associated with activities in which this muscle is active, such as lifting, gripping and/or grasping. Sports such as tennis or golf are commonly associated with this, but the problem can occur with many different activities.
This condition most commonly affects individuals between 30 and 50 years old, but it can occur in all ages and in both men and women.
Here are some potential causes of this condition:
Overuse: This can happen from “repetitive” gripping and grasping activities such as repetitive athletic movements or meat cutting, plumbing, painting, auto-mechanic work, etc.
Trauma: Although less common, a direct blow to the elbow may result in swelling of the tendon that can lead to degeneration.
Signs and Symptoms
Pain is the primary reason for patients to seek medical evaluation for tennis elbow. The pain is located on the outside of the elbow, over the bone region known as the lateral epicondyle. This area can become tender to the touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand. Occasionally, any motion of the elbow can be painful.
Treatment for tennis elbow is based on age, health, and response to conservative treatment. Some patients will find that their symptoms go away spontaneously within a year. For others, both surgical and non-surgical treatments are available. Non-surgical treatments are always considered first at Oregon Shoulder Institute.
Treatments can include:
Activity modification: Initially, the activity causing the condition should be limited. Modifying grips or techniques, such as use of a different size racket in tennis, may relieve the problem.
Medications: Anti-inflammatories such as ibuprofen (Motrin or Advil) and naproxen (Aleve) are used to reduce pain and inflammation. The max dose for ibuprofen is 800 mg three times per day. The max dose for naproxen is 500 mg twice daily. Prolonged usage should be avoided and these should be taken with food since they can affect the stomach lining. If one experiences an upset stomach these should be stopped.
Brace: A tennis elbow brace, a band worn over the muscle of the forearm just below the elbow, can reduce the tension on the tendon and allow it to heal.
Physical therapy: Stretching and/or strengthening exercises, ultrasound, or heat treatments may help the pain.
Injections: Injection of a steroid (cortisone) may be used to provide pain relief and facilitate physical therapy. We perform these injections with an ultrasound machine. This allows direct visualization of the joint and improved accuracy of the injection. Up to three injections over a two-year period are allowed. Beyond this there are typically diminishing returns and excessive injections may be detrimental.
Alternative injections include Toradol (an anti-inflammatory agent similar to ibuprofen), prolotherapy, or platelet-rich plasma (PRP). ). We use Toradol in people who do not tolerate steroids. Prolotherapy involves injecting a substance such as sugar into tissue to “stimulate a healing response.” PRP involves taking a small amount of blood from a patient, spinning in a centrifuge to separate the growth factors from the red blood cells, and then injecting the growth factors back into the elbow to potentially decrease pain.
Surgery is only considered when the pain is incapacitating and has not responded to other treatments, and when symptoms have lasted six to 12 months. Surgery involves removing the diseased, degenerated tendon tissue. This is an outpatient surgery option at Oregon Shoulder Institute.
Recovery from surgery will include physical therapy to regain motion of the arm. A strengthening program will be necessary to return to prior activities. Recovery can be expected to take several months.