ABC7’s The More in the Morning team spoke with Dr. Michael K. Kim, Board-Certified Plastic Surgeon, to discuss Lateral epicondylitis, better known as "Tennis Elbow."
What is "tennis elbow?"
Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities besides sports can also put you at risk.
Tennis elbow is inflammation or, in some cases, microtearing of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.
There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists and, in some cases, surgeons work together to provide the most effective care.
What causes "Tennis Elbow?"
Overuse
Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The ECRB muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.
The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.
Activities
Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle or repetitive extension of the wrist and hand.
Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.
Age
Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.
Treatments for Tennis Elbow
Nonsurgical Treatment
Approximately 80 to 95% of patients have success with nonsurgical treatment.
- Rest. The first step toward recovery is to give your arm proper rest. This means that you will have to stop or decrease participation in sports, heavy work activities, and other activities that cause painful symptoms for several weeks.
- Medications. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be taken to help reduce pain and swelling.
- Physical therapy. Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.
- Brace. Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons.
- Steroid injections. Steroids, such as cortisone, are very effective anti-inflammatory medicines. Your doctor may decide to inject the painful area around your lateral epicondyle with a steroid to relieve your symptoms.
- Platelet-rich plasma. Platelet-rich plasma (PRP) is a biological treatment designed to improve the biologic environment of the tissue. This involves obtaining a small sample of blood from the arm and centrifuging it (spinning it) to obtain platelets from the solution. Platelets are known for their high concentration of growth factors, which can be injected into the affected area. While some studies about the effectiveness of PRP have been inconclusive, others have shown promising results.
- Extracorporeal shock wave therapy. Shock wave therapy sends sound waves to the elbow. These sound waves create microtrauma that promotes the body's natural healing processes. Shock wave therapy is considered experimental by many doctors, but some sources show it can be effective.
Surgical Treatment
If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your doctor may recommend surgery. Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone.
The right surgical approach for you will depend on a range of factors. These include the scope of your injury, your general health, and your personal needs.
- Open surgery. The most common approach to tennis elbow repair is open surgery. This involves making an incision over the elbow. Open surgery is usually performed as an outpatient surgery. It rarely requires an overnight stay at the hospital.
- Arthroscopic surgery. Tennis elbow can also be repaired using miniature instruments and small incisions. Like open surgery, this is a same-day or outpatient procedure.