Tennis elbow (lateral epicondylitis)

Elbow

Tennis elbow (lateral epicondylitis) is an overuse injury to a tendon that connects the muscles of the forearm to the lateral epicondyle (a protruding bump on the underside of the humerus bone of the upper arm). It is a common injury not only in racquet sports players, but also in other types of athletes, as well as in anyone who places repetitive stress on the elbow, such as plumbers, carpenters, and industrial workers.

Diagnosis

The main symptom of tennis elbow is pain. However, the mechanism that causes the pain is not well understood. In general, patients can pinpoint the precise site of pain and describe which of their physical actions make the pain worse. Orthopedic surgeons use the physical examination and information obtained through magnetic resonance imaging (MRI) to confirm the diagnosis and rule out other conditions, such as nerve compression or a tumor. (Interestingly, some patients who have an MRI for other reasons may have evidence of tendon failure, even though they have no associated pain.)

Traditional and conservative therapies

In patients whose symptoms are not severe, an orthopedic surgeon may recommend a "wait and see" approach. These patients are also advised to modify their activities, reducing or completely stopping any activity that aggravates the condition. For those who play tennis, modifications to the way they play can be helpful, such as adjusting the strings or changing rackets, getting a larger grip, or using a different backhand (the tennis shot that puts the most stress on the tennis court). doll). For all patients, the use of over-the-counter anti-inflammatory medications such as ibuprofen and icing can also reduce pain. Physical therapy can also provide some relief by strengthening the surrounding muscles. Although some therapists recommend strengthening the wrist with weights, this particular exercise can aggravate the patient's pain. Some studies indicate that for most patients, pain on the outside of the elbow may go away on its own within a year or two. Patients whose symptoms persist, or who do not achieve adequate relief with these measures, may be candidates for an injection of cortisone (a powerful anti-inflammatory agent). As with the mechanism causing pain, the mechanism for pain relief provided by these injections is unclear, particularly in the absence of significant numbers of inflammatory cells. Some orthopedists have suggested that the insertion of the needle breaks up some loose tissue in the area that is causing pain. Patient responses to these injections vary. Some patients experience a period of pain relief that lasts from a few weeks to a few months, while others feel no benefit.

Surgical Treatments

For patients who are truly disabled by tennis elbow (many experience difficulties with daily functions as simple as picking up a cup of coffee, writing, or shaking hands) and have not benefited from conservative treatments, surgery may be recommended. There are two surgical techniques available: open surgery and elbow arthroscopy. Open surgery requires a larger incision and offers several options. A small bone chip may be removed, which can increase blood flow to the area and therefore promote healing and reduce pain. Alternatively, a small portion of the tendon can be released by cutting its connection to the bone. This reduces pain, but leaves most of the tendon still attached to the bone and functional, so there is virtually no loss of mechanical strength. The tendon can also be repaired by debridement, which means cutting the diseased part of the tendon and reattaching the healthy part to the bone. In arthroscopic surgery, two small cuts are made: one on the medial (inner) side and one on the lateral (outer) side of the elbow. The surgeon uses an arthroscope to clean up all of the torn tissue (in essence, cutting a small piece of the tendon). In general, no bone is removed. However, some surgeons abrade the surface of the bone with a motorized tool to create more blood flow to that area.

Recovery and Rehabilitation

After surgery, patients undergoing arthroscopic treatment are not fitted with a splint, but simply have their elbow covered and put in a sling. Gentle wrist and elbow stretching exercises may be started in the immediate postoperative period as tolerated. Supervised physical therapy is started if the patient fails to regain proper movement or strength.