Tennis Elbow

Overview

Tennis elbow, also called lateral epicondylitis is an overuse injury. It is caused by a repetitive strain over the tendon’s origin of the forearm muscles at the arm bone humerus (common extensor tendon origin). It is commonly seen in males, older than 40 years. The underlying micro-tear of the tendon causes pain and restricts the movement of the forearm, especially the twisting and rotating movements of the forearm.

Illustration, the origin of extensor muscles at the elbow, courtesy of The Journal of Musculoskeletal Medicine.

Symptoms

• Pain at the outer side of the elbow region
• Pain with resisted wrist extension
• Pain with gripping activities
• Decreased grip strength

Diagnosis

It is chiefly diagnosed through clinical examination

The following maneuvers exacerbate pain at the lateral epicondyle

• resisted wrist extension with the elbow fully extended
• resisted extension of the long fingers
• maximal flexion of the wrist
• passive wrist flexion in pronation causes pain at the elbow

Xrays of the elbow may show calcification

USG and MRI Scan to confirm the diagnosis and to rule out other conditions, such as nerve compression or a tumor. 

Treatment

Conservative Therapies

• Activity modification- Avoid the repetitive activity causing stress.
• Ice pack application can reduce pain and inflammation
• NSAIDs –reduce inflammation and pain
• Ultrasonic diathermy application, Interferential therapy and Splinting, Tennis elbow bands are recommended to provide pain relief.
• Physical therapy – provides some relief by strengthening surrounding muscles. Although strengthening the wrist 
• Corticosteroid/PRP (Platelet-rich plasma) Injection- Patients whose symptoms persist, or who do not achieve adequate relief from these measures, may be candidates for injection.

Surgical Treatments

For patients who are truly disabled by tennis elbow (many experience difficulty with such simple daily functions as lifting a cup of coffee, writing, or shaking hands) and have not benefited from conservative treatments, surgery may be advised.

Two surgical techniques are available – open surgery and elbow arthroscopy. 

Open surgery 

Requires a larger incision. A little chip of bone is removed that increases blood flow and promotes healing and reduces pain. Alternatively, a small portion of the tendon can be released by severing its connection to the bone. This reduces pain. Debridement of the unhealthy portion of the muscle.

Arthroscopic surgery

In this two small cuts are made: one on the medial (inner) side and one on the lateral (outer) side of the elbow. The surgeon uses an arthroscope to clean out all of the torn-off tissue.

Recovery and Rehabilitation

Following surgery, patients who have arthroscopic treatment are not splinted, but simply have the elbow covered and wear a sling. They may begin gentle stretching exercises of the wrist and elbow in the immediate postoperative period as tolerated. Supervised physical therapy is initiated if the patient is failing to regain adequate motion or strength in the month following treatment.

For patients who have open debridement, the wrist is usually splinted in extension for three to six weeks to allow healing of the repaired and reattached tendon. The patient then begins gentle stretching and strengthening with supervision of a physical therapist or hand therapist.