What is Tennis Elbow?
Inflammation of the tendons that attach the muscles of the forearm to the outside of the elbow is called Tennis Elbow. The long bone in the upper arm known as the humerus articulates with two bones in the forearm known as the radius and ulna. Several ligaments form a joint capsule at the elbow connecting these bones to each other. Tendons attach the extensor muscles of the forearm to the arm bones to produce movement. The lateral epicondyle, a bony bump on the outer aspect of the humerus, is the site of attachment for several of the forearm muscles including the Extensor Carpi Radialus Brevis (ECRB). When the elbow is straight the ECRB muscle helps to stabilize the wrist. Tennis elbow, also known as Lateral Epicondylitis, is often the result of inflammation of the ECRB tendon.
What causes Tennis Elbow?
While common amongst individuals ages 30 to 50 that play racket sports, Tennis Elbow can affect anyone. Carpenters, plumbers and butchers are also prone to developing this disorder. Most frequently it is caused by muscle strain and overuse. Due to its location in the forearm, the ERCB muscle rubs against the bony epicondyle. Microscopic tears can form in the ERCB tendon producing inflammation.
What are the symptoms of Tennis Elbow?
Pain or tenderness to the outer aspect of the elbow is characteristic of Tennis Elbow. The pain can vary from mild to severe and is often worse after activity. Muscle weakness or decreased grip strength can also occur and the dominant arm is more frequently affected. Those with mild symptoms report pain relief associated with rest.
How is Tennis Elbow diagnosed?
A thorough history and review of symptoms is helpful in determining diagnosis. The physician will consider various factors including age, occupation and recreational activities. During examination, the doctor may manipulate the arm in different positions and apply pressure to see which actions induce pain. X-rays or other imaging tests may be used to exclude other pathology and assess the soft tissues.
How is Tennis Elbow treated?
The majority of patients will have success with conservative treatment alone. Resting the affected arm is the crucial to recovery. Cold compresses may provide significant relief from swelling in the initial phase of treatment. NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen and aspirin can help reduce pain and inflammation. In more severe cases an injectable steroid may be used, however the effectiveness may diminish over time. A special forearm brace can relieve symptoms and reduce stress on the affected area and palm up lifting is recommended. The doctor or therapist will endorse special exercises to stretch and strengthen the muscles, as well as various muscle stimulating techniques to support healing.
In severe cases or those that do not respond to conservative treatment, surgery may be indicated. The procedure is usually performed on an outpatient basis. A small incision is made on the outside of the elbow. Any scar tissue and diseased muscle is removed. The healthy muscle tissues are reattached to the bone and the incision is sutured closed. A brace is worn for about 3 weeks to completely immobilize the elbow. Therapy begins once the brace is removed and full recovery can be expected at 3 months.
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.
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