Lateral Epicondylitis (Tennis Elbow)
Why Does It Occur?
Lateral epicondylitis is an overuse injury that leads to injury to the common wrist extensor tendon origin at the lateral epicondyle (bony prominence on the lateral aspect of the elbow). Like other forms of tendonitis, it typically represents an injury process that supersedes the body's normal healing process, although one sudden traumatic event can also cause it. It is commonly referred to as "tennis elbow" since it is common in tennis players. However, it can occur in anyone who performs repetitive gripping or wrist extension activities.
Symptoms of lateral epicondylitis include pain and tenderness over the outside portion of the elbow especially with gripping or wrist extension. This pain may also radiate down the forearm. Patients often complain of pain with taking a gallon of water out of the refrigerator, taking trash out of the trashcan, working out with weights in a gym, playing any racquet sports or golf, or even when shaking hands.
X-rays are normally ordered to rule out a calcification (deposition of calcium) within the common extensor mass or other diagnoses. An MRI may be ordered to determine the severity or stage of the problem, including whether there is inflammation, a partial tear, or a full tear of the tendon.
Non-operative treatment is the mainstay of treatment for anyone who doesn't have a full tear of the tendon. The first steps in management usually consists of activity modification to decrease gripping or wrist extension activities, physical therapy, and bracing. Bracing consists of wearing a wrist immobilizer for 2 weeks and a counterforce elbow brace (reduces tension on the common extensor tendon origin) for 6 weeks. Nonsteroidal anti-inflammatory drugs (NSAID's) and frequent use of ice can help with the pain, especially when there is inflammation.
Should symptoms persist, or if there has been a sudden traumatic event, or if the pain is intolerable, the next step is usually an MRI to evaluate for tears of the common extensor tendon. If inflammation is the predominant issue without evidence of tendon tear, a cortisone injection may be cautiously suggested. If a partial tear is found, Dr. Lee may suggest injections of Platelet-Rich Plasma (PRP). More information on PRP injections can be found in the PRP section of the website.
Dr. Steven Lee was one of the first physicians in NYC to utilize PRP and has been a leader in treating this disorder. He arguably has more experience with PRP for lateral epicondylitis than any other orthopaedic surgeon in NYC, and has successfully treated countless number of patients with this modality. Learn more about PRP here.
Surgery is reserved for those who either have a full tear of the tendon or fail non-operative management. Through an incision typically between 1-2 inches long, Dr. Lee will excise a small portion of degenerative/inflamed tendon and then suture the remaining aspects of the tendon together. Dr. Lee will also drill very small holes into the lateral epicondyle to increase blood supply to the area in an effort to improve the healing process. The surgery is typically done in an outpatient setting and Dr. Lee often takes less than 15 minutes to perform. While Dr. Lee is an expert arthroscopic surgeon, he not only does not believe the arthroscopic method yields a benefit over the open method, but feels the results are inferior, and therefore prefers not to treat this diagnosis in this manner. Learn more about scheduling surgery.
All surgical patients are immediately immobilized in a non-removable splint above the level of the elbow for 7-10 days following surgery. During this time, patients are encouraged to elevate their hand above their heart, keep their dressings clean and dry, and to move their fingers. Patients are allowed to use their fingers to text and type, but not to lift anything heavier than a cup of coffee or that which causes them more than a 2/10 pain level.
Patients will then be transitioned into a locked elbow brace and wrist immobilizer for 3 weeks. After this, the patient will be required to wear a wrist immobilizer for an additional 3 weeks and start occupational therapy (OT) to regain back strength and mobility. While many patients will be surprisingly functional 6 weeks out from surgery, it often takes up to 4-6 months to be cleared for all activities including sports.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.