What is Tennis Elbow?
Movement of the elbow is made possible by the coordinated action of the arm bones, the muscles of the forearm, and their tendons. The bony framework of the arm includes the humerus, and the two forearm bones: the radius and ulna. Tennis elbow is pain at the outer edge of the elbow, specifically over the humerus where it bulges at the joint. This area is called the lateral epicondyle and for this reason, tennis elbow is also known as lateral epicondylitis. Several muscles and their tendons attach to the lateral epicondyle. The Extensor Carpi Radialis Brevis muscle (ECRB) and its associated Common Extensor Tendon are most often implicated in tennis elbow. This muscle and tendon duo are activated during extension of the wrist.
What Causes Tennis Elbow?
In tennis elbow, repeated trauma to the ECRB muscle causes microtears in the muscle where it attaches to the lateral epicondyle. This can lead to inflammation, pain, and over time, scarring. While common in tennis players, it can occur in anyone whose occupation or hobby involves repeated use of the forearm muscles, especially in conjunction with extension of the wrist. Increased age is also a factor in degeneration of the attachment of the muscles to the lateral epicondyle.
What are the Symptoms of Tennis Elbow?
Tenderness, pain and/or swelling at the lateral epicondyle of the elbow is the classic presentation of tennis elbow. Pain can also be elicited by extending the wrist against resistance when the elbow is held straight.
How is Tennis Elbow diagnosed?
The diagnosis of tennis elbow is made based on a careful history and thorough physical examination. X rays are useful to rule out other pathology in the elbow joint and MRI may be utilized to assess the condition of the affected muscles and tendons. Lab tests are not needed.
How is Tennis Elbow treated?
Tennis elbow can be treated non-surgically or surgically, depending on the individual and the severity of the symptoms.
Rest is the cornerstone of non-surgical treatment for tennis elbow. Oral medication such as NSAIDs or oral steroids may be prescribed to decrease inflammation and pain. Lifting with the palm up to decreased the stress to the muscles is effective. A counterforce strap or brace tightened over the extensor muscles is critical during activities decreased stress to the injured area. Physical therapy can strengthen the muscles of the forearm once the inflammation in the elbow has resolved. Modifications in the workplace such as braces, ergonomic adjustments, or equipment resizing may be helpful for long term relief. If all of this has failed, as a last resort prior to surgery, a cortisone injection may be helpful.
Most cases of tennis elbow resolve with non-surgical interventions. However, severe cases may need surgery. Surgery is performed under general anesthesia, and is done on an outpatient basis. Tennis elbow surgery is complex and multifaceted, and is tailored to the specific type of injury sustained.
In the traditional open method of repair, an incision is made on the lateral aspect of the elbow. This allows visualization of the underlying structures with the naked eye. Debridement of scar tissue is performed and tears in the extensor muscles are repaired. If needed, a small portion of affected tendon can be released, bone spurs are filed down, and the bone is drilled to increase blood flow and facilitate the healing process. The wound is sutured and the arm is immobilized in a full length splint for 8 to 10 days. When the splint is removed, a physical therapy program is started that usually lasts four to six weeks.
See an illustration of the open method of repair on the video below.
Arthroscopic, or Closed Method
Technological advances have made it possible to repair some cases of tennis elbow arthroscopically. In Arthroscopic Tennis Elbow repair, three small incisions are made, and with the aid of a tiny camera to visualize the elbow joint, a thin probe is used to debride, or remove, the scar tissue present on the muscles or ligaments. Unfortunately, the endoscope does not allow a full range of interventions that may be needed to repair tennis elbow, limiting its usefulness.
Mini Open Method of Repair
Dr. Knight has favors the “mini-open” method. With this method, he is able to perform the full range of treatment available with a traditional open surgery, while avoiding the pitfalls of a larger incision. The resulting scar tissue is smaller, more aesthetically pleasing, less tender, and heals faster.
Only a trained orthopedic surgeon can determine which type of repair is right for you. Dr. Knight has had extensive experience with all three methods of repair, and has the equipment and experience needed to offer you the best treatment for your particular tennis elbow injury should you need surgery.
How can Dr. Knight help you with lateral epicondylitis or tennis elbow?
Dr. Knight will take a careful history and examination and once he has confirmed the diagnosis he will start a comprehensive conservative program to relieve your pain. In most cases your symptoms will resolve without surgery. If surgery is necessary, a minimally invasive procedure will be recommended to minimize scarring allowing a quick recovery.
Tennis Elbow Testimonial – Nina Taylor
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