What is Tennis Elbow?

Tennis elbow is a common condition that causes pain in the lateral aspect of the elbow.  This condition represents one of the most common reasons for elbow pain seen in  an orthopedic practice.  Oftentimes, the patient’s pain occurs not because of tennis or any other athletic endeavor, but  occurs because of a repetitive overuse mechanism of injury.  Using a keyboard or mouse is often the cause of pain.  The pain results from degeneration of the extensor tendon insertion of the muscles of the forearm and wrist.

Workup for this problem includes plain x-rays.  The purpose of obtaining plain x-rays is to ensure that there is no other elbow pathology responsible for the patient’s pain.  Elbow x-rays tend be normal when a diagnosis of tennis elbow is made but other conditions such as elbow arthritis can be excluded by obtaining plain x rays.  Perhaps, the most important factor in diagnosing tennis elbow is the fact that the patient is tender to touch over the lateral epicondyle. The patient will also have pain with resisted wrist extension.  MRI is seldom required to make the diagnosis of tennis elbow because clinical examination and history are usually sufficient to make this diagnosis.

The treatment of tennis elbow begins with activity modifications.  As tennis elbow is often caused by a repetitive overuse type of mechanism, any steps to alleviate the causative factors will be helpful.  If in fact tennis elbow is caused by tennis, minor modifications such as changing the grip of the tennis racket to a more appropriate size may alleviate symptoms.  When tennis elbow is caused by computer use, minor modifications to the patient’s workstation to make access to the keyboard or mouse easier will often alleviate some of the symptoms.  Orthopedically, treatment includes anti-inflammatories as well as a tennis elbow strap.  Tennis elbow straps are available at many local stores such as Target and Walmart, and are certainly available at medical supply stores or through prescription. The orthopedic surgeon with the patient’s permission may elect to inject the elbow with cortisone.  The risks of cortisone injection include skin depigmentation as well as fat atrophy.  This is a very seldom seen complication of subcutaneous cortisone injections but is sometimes seen nonetheless.  Physical therapy is also very helpful to treat this condition.  Rarely, does a patient require surgery for this condition.  In fact, less than 5% of patients will ever require surgery for tennis elbow.  The reason that very few patients require surgery for tennis elbow is secondary to the fact that a lot of patients symptoms will eventually “burnout” over a year to 18 months even if no treatment is instituted.

Other alternative treatments for tennis elbow include injection of the lateral epicondyle with platelet derived growth factor.  Platelet-derived growth factor involves aspiration of the patient’s blood which is spun down in the centrifuge to collect the platelets which have healing factors which may help tennis elbow resolve when injected back into the lateral elbow.  Oftentimes, insurance does not cover this procedure and this is an out-of-pocket expense for patient’s.  Given failure of patient’s pain to resolve for at least 6 months, the patient may consider the option of surgery.  The surgery involves a small open incision over the lateral epicondyle.  Dissection is carried down through the tendon which is most commonly involved with tennis elbow, the extensor carpi radialis brevis.  This tendon is debrided and small drill holes are made in the lateral epicondyles to promote regeneration of the tendon.  This is a very short, simple  procedure that takes less than 15 minutes to perform.  Even though this procedure is very simple, the vast majority of patients resolve their pain without need for surgical intervention.

Written by Dr. Frank Moussa

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