Tennis elbow, also called lateral epicondylitis, is an inflammation of the lateral (outside) bony protuberance at the elbow. It is at this protuberance that the tendon of the long muscles of the hand, wrist and forearm attach to the bone. As the muscles repeatedly and forcefully contract, they pull on the bone, causing inflammation. The trauma is especially irritating when working the muscles in an awkward position with poor leverage such as hitting a backhand in tennis.
It is not unusual for a patient to come to my office with severe pain on the outside of his elbow after intensifying their tennis workouts or changing the racquet string tension. Others come to me with pain on the inside of the elbow (“golfer’s elbow”) from wrist action that advanced golfer’s use at impact. For that matter, laborers working with wrenches or screwdrivers with an awkward or extended arm can also develop tennis elbow.
In a more chronic problem, lateral elbow pain may be caused by a degenerative condition of the tendon fibers on the bony prominence at the lateral elbow. Sporadic scar tissue forms from a poor attempt by the body to overcompensate and heal without eliminating the cause.
Common characteristics of persons who develop tennis elbow:
While symptoms may vary, pain on the outside of the elbow is almost universal. Patients also report severe burning pain that begins slowly and worsens over time when lifting, gripping or using fingers repetitively. In more severe cases, pain can radiate down the forearm.
Conservative treatment is almost always the first option and is successful in 85-90 percent of patients with tennis elbow. Your physician may prescribe anti-inflammatory medication (over the counter or prescribed). Physical/Occupational therapy, rest, ice, and a tennis elbow brace to protect and rest the inflamed muscles and tendons may be advised. Ergonomic changes in equipment, tools, technique and work-station may be necessary. Improvement should be noticed in 4-6 weeks. If not, a corticosteroid injection may be needed to apply the medication directly to the inflamed area. Physical therapy range of motion and stretching exercises to the affected muscles and tendons may be necessary prior to a gradual return to activity. Deep friction massage can assist healing.
Exercises are performed in a particular manner to isometrically hold and eccentrically lengthen the muscle with contraction.
New Conservative Treatment: Platelet-Rich-Plasma (PRP) is a new treatment for the conservative management of degenerated soft tissues that has recently received great media attention, in great part, due to its success in several high profile athletes. According to the Journal of the American Academy of Orthopaedic Surgeons,(JAAOS) platelet-rich plasma (PRP) is autologous (self-donated) blood with an above normal concentration of platelets. Normal blood contains both red and white blood cells, platelets and plasma. Platelets promote the production and revitalization of connective tissue by way of various growth factors on both a chemical and cellular level.
The actual PRP injection requires the patient to donate a small amount of their own blood which is placed into a centrifuge (a machine that spins the blood at a high velocity to separate the different components of blood such as plasma, white and red blood cells), for approximately15 minutes. Once separated, the physician draws the platelet-rich plasma to be injected directly into the damaged tissue. In theory, the high concentration of platelets, with its inherent ability to stimulate growth and regeneration of connective tissue, will promote and expedite healing at the site of damage.
Surgery for tennis elbow is only considered in patients with severe pain for longer than 6 months without improvement from conservative treatment. One surgical technique involves removing the degenerated portion of the tendon and reattaching the healthy tendon to bone. Arthroscopic surgery has recently been developed to perform this technique; however, research does not support the value of one over the other at this point. Physical/occupational therapy is used after surgery. Return to work or athletics may require 4-6 months. More recently, a surgical technique using ultrasound to guide a needle to debride (clean) the area of scar tissue has been developed. If eligible for this procedure, the time required for healing, rehabilitation and return to activity is much shorter.
If you feel you suffer from tennis elbow, ask your family physician which of these treatment options are best for you.
Visit your doctor regularly and listen to your body.
NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in Scranton, PA. He is an associate clinical professor of medicine at The Commonwealth Medical College.