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.

Causes

Tennis Elbow most commonly occurs in individuals between the ages of 30 and 50 years old. Tennis Elbow is caused by chronic stress to the forearm muscles, especially the Extensor Carpi Radialis Brevis. The repeated motions and stress can cause the tendon to degenerate (tendonopathy). As the name Tennis Elbow implies, playing tennis or other racquet sports is one cause of the condition; particularly, repeated use of the backhand stroke, forearm stroke, or serve with poor athletic form. Many individuals develop Tennis Elbow for no identifiable reason.

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. The physical or occupational therapists focus on improving physical functioning for participation in activities. The therapies address muscle strength, flexibility, endurance, and coordination. This method is successful for many individuals with Tennis Elbow.

Surgery

The majority of individuals with Tennis Elbow do not require surgery. Surgery is considered if significant pain continues after at least six months of treatment. The surgery is performed as an outpatient procedure. The individual may remain alert with regional anesthesia or be sedated for the surgery. The surgeon makes a small opening at outside of the elbow bone and then removes any injured tissue and reattaches the tendon to the bone. Recently, an arthroscopic surgery method has been developed. Arthroscopic surgery uses a small camera, called an arthroscope, to guide the surgery. Only small incisions need to be made and the joint does not have to be opened up fully. This technique can provide a positive outcome and a shortened recovery time.
 

Following surgery, the elbow is placed in a small splint. After about one week, the individual can begin physical or occupational therapy to stretch the elbow joint and increase motion. Muscle strengthening can begin at about two months after the surgery. Individuals typically return to full activity levels four to six months after surgery. Tennis Elbow surgery produces successful outcomes for the vast majority of individuals.  

Recovery

With non-surgical treatments, symptoms of Tennis Elbow may be relieved as early as four to six weeks. However, many individuals have chronic symptoms for many months. Individuals requiring corticosteroid injections or surgery may take several months to recover, but typically can achieve good results. Tennis Elbow does not usually lead to severe problems if it is treated. If left untreated, it rarely leads to loss of motion and function.