Tennis elbow, also called lateral epicondylitis, is a disorder that involves inflammation of the extensor tendons and muscles of the outside of the elbow. While often associated with tennis, lateral epicondylitis can be the result of any activity that involves repetitive gripping or extension of the wrist. Overuse due to repeated motions that occur during recreational sports or work can inflame and/or damage these tendons. Activities such as gardening, typing, yard work, and weight lifting are commonly associated with “tennis” elbow. People with certain occupations such as cooks, servers, painters, carpenters, masons and other manual hands-on work also commonly suffer from this problem.
The upper arm bone, which is known as the humerus, has bony bumps on the inside (or medial side) and the outside (or lateral side) of the bone at the elbow. These bumps are called the lateral and medial epicondyles. These epicondyles are the attachment points for the tendons of the muscles that move the wrists and hands. Tendons are structures that attach muscle to bone. The tendons for the muscles that are used to extend your wrist and fingers are attached to this outer bony bump or lateral epicondyle. Epicondylitis is the inflammation of these tendons at the point where they attach to the epicondyle. Repetitive activity causes this problem by putting more stress on the attachment site of the tendon than it is able to withstand. Because gripping also requires slight wrist extension, repeated squeezing of objects or shaking hands can also precipitate or exacerbate lateral epicondyltis.
The hallmark of tennis elbow is tenderness and pain in the general area of the lateral epicondyle, especially with active wrist extension. It can begin slowly or become extremely painful very fast. Picking up a briefcase or a suitcase or a gallon of milk suddenly becomes an excruciating process. Gripping an object or shaking hands can cause tears. While a very benign sounding process, tennis elbow can cause a significant decrease in quality of life and getting rid of it soon becomes the focus of the involved patient.
Tennis elbow has many treatment options, most of them conservative in nature. All of these involve initial removal of the pain and inflammation, followed by a stretching and exercise program designed to prevent recurrence. Pain relief is obtained with the use of inflammation removing medication. This usually starts with oral anti-inflammatories, but it is not uncommon to progress to a cortisone shot into the lateral epicondyle if the oral meds do not work or the presenting symptoms are severe. A wrist extension brace is often used to immobilize and rest the inflamed muscles. Once initial pain relief is obtained, a stretching program for the wrist extensors is gently begun. A gentle wrist extensor-strengthening program is started when the pain is completely gone. Because it is usually a fairly straightforward diagnosis, rarely is it necessary to do multiple tests or procedures, unless the patient has a very atypical presentation.
A majority of patients (>85%) will recover through nonsurgical treatment. This treatment includes rest, physical therapy, bracing, medicines, and/or steroid injection. Up to three steroid shots can be given into the epicondyle. Rarely, more aggressive treatment is tried such as injection of Platelet Rich Plasma or treatment with extracorporeal shock wave therapy. If all other efforts fail, some patients may be considered candidates for outpatient surgery. Your orthopaedic surgeon will discuss the options and whether a surgical procedure may meet your individual needs.