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Tennis Elbow

(lateral epicondylitis)

 

This is a very common condition causing pain on the outside of the elbow and forearm.  Repetitive grasping, lifting and twisting activities of the wrist and hand are usually the cause.  Any repetitive activity with the palm in a downward position can cause an overloading phenomenon of the muscles on the top of the forearm.  This causes “microscopic tearing” of the tendon fibers where they attach on the bony prominence on the outside of the elbow.

Common activities that lead to “tennis elbow” include --

 

  • Lifting luggage or groceries
  • Gardening, use of pruning shears and gardening clippers, etc. 
  • Extensive piano playing
  • Extensive keyboarding on computers
  • Weightlifting
  • Extensive handwriting
  • Tool work, such as swinging a hammer, twisting a screw driving, etc.  

 

The common theme in these activities are repetitive grasping with the palm down.  In order to form a power grasp the wrist must be in the upward (dorsiflexed) position.  This overloads the extensor muscles and causes pain, inflammation and swelling.

 

Treatment

 

Activity Modifications:

  • Decrease lifting activities.
  • Lift objects with the palm up.
  • Offload weights to the unaffected arm
  • Tennis Elbow Strap (Counterforce bracing)-Place this narrow strap, which should be 1 to 1-1/2 inches in width, around the upper forearm located 1-1/2 to 2 inches below the outer bony prominence on the elbow.  This is usually a pad, which can be made of foam, gel or air.  It should be placed in a line drawn from the bony prominence (lateral epidcondyle) on the outside of the elbow to the base of the thumb.  Again, the pad should be located 1-1/2 to 2 inches below the bony point on the outer elbow along this line
  • Ice
  • Topical Heating Rubs- Mineral ice, Tiger balm, Deep heating rubs/Ben Gay
  • Stretches-These are extension stretches.  Holding the elbow in a fully straightened position, grasp the wrist and bend the wrist down, feeling the pulling sensation on the elbow.  This stretch should be maintained for a 20-second count and then repeated 10-15 times.
  • Cortisone Injections (corticosteroid injections with lidocaine)- If the symptoms are severe and have been present for greater than 2 to 3 months, a cortisone injection is a highly effective way of reversing the inflammation, allowing the tissues to heal.   These usually work within 1 to 3 days from the time of the injection.  Serial cortisone injections, up to 3 to 4 injections over 3 to 6 month period are considered standard conservative treatment for this condition.  Many patients have a low grade chronic recurrent case of tennis elbow that requires  more injections over a longer period of time.  Many patients have a low-grade chronic recurrent case of tennis elbow that requires more injections over a longer period of time.

 

Physical Therapy

 

This works by reducing inflammation with the local modalities of heat, ice, ultrasound and electrical stimulation.  A strengthening and stretching program is also performed.

 

Surgery

 

For chronic severe cases, surgery provides a predictable cure for this condition.  Most patients on average have had symptoms for over 12 to 18 months and have exhausted all conservative therapies prior to performing surgery.  The procedure is performed through a small 1 to 1-1/2 inch incision to release the tendon down to its bony attachment point; then remove the bony lateral epicondyle and repair the tendon down to the base of the newly freshened bone.  This procedure is felt to work by both allowing the tendon to heal in a slightly more relaxed position so there is less tension on it, as well as, allowing the tendon to heal “freshly” to the bone.