August 2010 Newsletter

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Tennis Elbow
By Dr. Stephen A. Hunt

What is Tennis Elbow?
Lateral Epicondylitis, also known as “Tennis Elbow,” is a very common ailment of the elbow. This pain on the outside of the elbow got its name back in 1873 by a German physician who called it roughly “lawn-tennis arm.” It affects both men and women in their 40s and 50s. It can affect both dominant and nondominant arms and is not limited to people who play racquet sports.

What is the lateral epicondyle?
The lateral epicondyle of the elbow is a bony prominence at the end of the humerus (or arm bone). Several muscles have tendons that originate from the lateral epicondyle. These muscles extend the wrist and the fingers. Additionally, there are ligaments that stabilize the elbow joint at this location. Finally, one of the main nerves to the hand has some branches in this region as they course towards the hand.

What are the symptoms of lateral epicondylitis?
Most patients complain of pain at the outer part of their elbow. It may radiate down the forearm to the hand or up the outer arm to the shoulder. Weakness in the hand is not common, however, many people will feel relatively weak because picking up a gallon of milk or even a coffee mug will cause a sharp pain at the elbow which forces them to release their grip. Sharp pains and stiffness with extension of the elbow are often noted early in the morning or after periods of inactivity.

What are the causes of lateral epicondylitis?
Classic lateral epicondylitis is felt to be a result of an injury (usually repetitive in nature) to one of the muscle tendons – the extensor carpi radialis brevis. Some people have no known repetitive injury and age related changes in the quality of the tendon might be a cause of this problem. One theory behind the muscle tendon as a source of pain is that there is a failed healing response in the tendon, which causes a higher sensitivity of pain receptors in that region. There are some other problems that can cause pain in this location but are less common such as nerve entrapment, arthritis of the elbow joint, and instability of the elbow.

How is Lateral epicondylitis diagnosed?
The patient’s complaints are usually specific to this diagnosis. However, physical examination and x-rays (to rule out any arthritis) are often required to confirm the diagnosis. Occasionally, an MRI may be ordered to rule out any other problems or in cases of preoperative planning.

How do you treat lateral epicondylitis?
The natural history of lateral epicondylitis suggests that the symptoms will resolve in a majority of cases by 12 to 18 months. However, there are many interventions that may reduce the symptoms and possibly shorten the course of this problem – though none has been proven to “cure” this problem. Modifications to exercise, such as increasing your grip size on a racquet or not gripping weights frequently may alleviate many of the symptoms. Non-steroidal anti-inflammatory medications (i.e., ibuprofen, naproxen) may reduce symptoms. Physical therapy (at home or with a professional) may also provide relief. Bracing in the form of a forearm strap or a wrist splint may also help this problem. Injections may also provide some relief. Injections may be performed with steroid, botulinum toxin (Botox), or platelet rich plasma (PRP). Finally a small percentage of people (5-10%) who cannot get relief from these methods may have surgery to cut out the damaged and irritated tendon. This can be performed either through an open incision or an arthroscopic approach.

How do I prevent this problem?
Unfortunately, there is no known prevention for this problem as the causes are multifactorial. However, should you develop this problem, it does not cause long term lasting problems or permanent deficits.

REFERENCES:

1. Calfee RP et al. Management of lateral epicondylitis: current concepts. J Amer Acad Orthop Surg 2008; 16: 19-29.
2. Nirschl RP, Pettrone FA: Tennis elbow: The surgical treatment of lateral epicondylitis. J Bone Joint Surg 1979; 61: 832-39.
3. Nirschl RP, Ashman ES: Elbow tendinopathy: Tennis elbow. Clin Sports Med 2003; 22:813-36.