Sports Medicine

Tennis Elbow (Lateral Epicondylitis)

Anatomy

The elbow is a complex joint that allows bending and straightening (flexion and extension), and forearm rotation (pronation, palm down; and supination, palm up). The elbow is formed by the joining of three bones: the upper arm (humerus), the forearm on the pinky finger side (ulna), and the forearm on the thumb side (radius). The surfaces of these bones, where they meet to form the joint, are covered with articular cartilage, a smooth substance that protects the bones and acts as a natural cushion to absorb forces across the joint. A thin, smooth tissue, called synovial membrane, covers all remaining surfaces inside the elbow joint. In a healthy elbow, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction as you bend and rotate your arm.

Held together by muscles, ligaments and tendons, the elbow is a combination hinge and pivot joint. The hinge part of the elbow allows the arm to bend like the hinge of a door, while the pivot part makes it possible for the lower arm to twist and rotate. There are several muscles, nerves and tendons that cross at the elbow.

Description

Lateral epicondylitis, more commonly known as tennis elbow, is a painful condition that occurs when overuse results in inflammation of the tendons that join the forearm muscles on the outside of the elbow. (Golfer's elbow, medial epicondylitis, is a similar condition that affects the inside of the elbow.) Recent studies show that tennis elbow is often due to damage to the extensor carpi radialis brevis (ECRB), a specific forearm muscle that helps stabilize the wrist when the elbow is straight.

Causes

Participation in sports, work, or other recreational activities that require repetitive and vigorous motion may result in the overuse that leads to tennis elbow. Many who are not athletes also suffer from this condition.

Symptoms

Common symptoms of tennis elbow include:

• Pain or burning on the outer part of the elbow
• Weak grip strength

Nonsurgical Treatment

The majority of patients (approximately 80-95%) have success with nonsurgical treatment.

• Rest—Modify or discontinue participation in activities that aggravate the condition. Giving the arm proper rest is the first step toward recovery.
• Nonsteroidal anti-inflammatory medication—Drugs such as aspirin and ibuprofen may help reduce pain and swelling. Most people are familiar with these nonprescription NSAIDS, however, whether taking them in over-the-counter or prescription strength, they must be used carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.
• Physical therapy—Your doctor may recommend specific exercises to help strengthen the muscles of your forearm.
• Brace—Using a brace centered over the back of your forearm may help reduce symptoms by allowing muscles and tendons to rest.
• Steroid injections—Steroids, such as cortisone, are very effective anti-inflammatory medications and may be recommended for some patients.
• Platelet-rich plasma (PRP)—A relatively recent treatment option, PRP therapy, is currently being studied by researchers and is considered by some to hold promise for certain injuries. Contact your orthopaedic surgeon to find out if this treatment would be appropriate for you.

Surgery

If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your orthopaedic surgeon may recommend surgical treatment. With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.