Tennis Elbow – Lateral Epicondylitis

Introduction

Tennis Elbow is a condition that results in deterioration of the tendon fibers that attach to the bone at the outside of the elbow. Tendons are strong fibers that attach muscles to bone. They are tissues that do not stretch easily and are susceptible to degeneration under repeated or traumatic stress. Another name for Tennis Elbow is Lateral Epicondylitis. The pain of Tennis Elbow occurs primarily where the tendons of the forearm muscles attach to the elbow bone at the Lateral Epicondyle. Playing racquet sports is only one cause of Tennis Elbow.

Anatomy

A tendon anchors the forearm muscles to the outer (Lateral) side of the elbow bone (Epicondyle). The forearm muscles, particularly one called the Extensor Carpi Radialis Brevis, work together to raise the hand at the wrist joint. These forearm muscles are called the “wrist extensors” because they allow the hand to move upward or extend, such as when making the hand motion for “stop.” Repeated use of the wrist extensors can cause microscopic tears in the tendon. Individuals with tendon tears or degeneration can develop forearm muscle weakness along with swelling and pain at the outside of the elbow.

Symptoms

Individuals with Tennis Elbow frequently experience severe burning pain and tenderness at the outer side of their elbow and forearm. In most cases, the pain starts out slow and mild but gradually increases over weeks or months. The pain may increase with movement or when pressure is applied to the outer elbow area. Some individuals experience morning stiffness, muscle weakness, and aching throughout the day. They may be unable to perform the motions necessary to complete various tasks. Some individuals may even feel pain when they are not moving their arm.

Diagnosis

A physician will perform an examination and review the individual’s medical and activity history to make a diagnosis of Tennis Elbow. The physician evaluates the forearm structures by using simple tests. The history and examination, supplemented with X-rays of the elbow are sufficient to make the diagnosis. X-rays may be used to assess if the elbow bone was injured and help rule out other possible causes of elbow pain, such as arthritis. When taking an x-ray, a camera focuses on the elbow area and a picture is taken. Magnetic Resonance Imaging (MRI) scans are rarely used to diagnose Tennis Elbow however MRI scans may be used to provide a very detailed view of the tendon injury. The MRI equipment takes images by focusing on the elbow area. Both imaging techniques are painless and require that the individual remain very still.

Treatment

Most cases of Tennis Elbow respond to non-surgical treatments. Treatment typically includes rest or activity restriction/alteration. Specific exercises, often under the guidance of a therapist, are often prescribed. Physicians may instruct the application of ice to the affected areas or recommend medication to relieve pain. Wrist splints and forearm bands can be used to relieve symptoms and promote healing.
Tennis Elbow may also be treated with corticosteroid medications. Corticosteroid medication is a relatively safe pain reliever and in the case of tennis elbow would be injected at the outside of the elbow. After the pain is relieved, physical or occupational therapy may be needed.
If conservative Treatment and Physical Therapy Failed:
Ultrasound Guided Platelet rich plasma injection or Stem Cells injection for regeneration is promising (not FDA approved) but supported by multiple Studies.