Lateral Epicondylitis…aka Tennis Elbow

 Most patients I see with tennis elbow haven’t picked up a racket in 20 years.  Most professional tennis players have never suffered from tennis elbow :-).  As such, tennis elbow is not a very accurate name.

Tennis elbow or lateral epicondylitis falls into the broad category of  tendinopathies.  A tendinopathy is a condition that can affect any of the tendons we have in our body.  The tendons which are most commonly affected are the rotator cuff (shoulder), the elbow tendons, the quadriceps tendon  and achilles tendon.  We used to refer to this situation as a tendonitis.. where the -itis means inflammation.  The term we now use is tendinosis, because it turns out that these tendinopathies are not inflammatory in nature. Lateral epicondylitis and other  tendonopathies  are a degenerative disease.  The tendon is changing due to age, activity, chronic stress or even genetics.  We do not know exactly why.. but something is causing the tendon to change at its cellular level. The degeneration caused by tendinosis can eventually lead to fraying and tearing of the tendons around the elbow.

What are the symptoms of Tennis Elbow?

Tennis elbow is characterized by pain on the outer side of the elbow, near a boney prominence we call the lateral epicondyle….hence the name.  The pain can be quite severe and quite disabling.  At it’s worst, you will have difficulty even lifting up a cup of coffee in the morning.

The onset of symptoms can be abrupt or acute, or the elbow pain can build up slowly over time.

Treatment of Tennis Elbow.

Treatment is geared towards eliminating offending activities, ice, stretching, perhaps even counter force bracing.  Absent any success with these simple methods we may try injections and even surgery to alleviate your discomfort.  An  article  in the NY Times demonstrates how a simple $30 eight inch rubber bar alleviated symptoms that months of injections and formal physical therapy couldn’t.

Many patients who have failed to improve with rest, ice,  and therapy also chose to try a platelet rich plasma (PRP) injection prior to considering surgery.

Bottom line, in most people, the pain of tennis elbow is usually self limiting and will go away spontaneously.  In those who have very severe pain,  a “flexbar” program may help and an injection to “cool down” the elbow may allow you to perform the exercises with less discomfort.  Only if you fail to improve with these modalities and the pain significantly interferes with your quality of life should you need to find yourself considering surgery.

Alternatives for treatment of lateral epicondylitis (tennis elbow) are physical therapy, steroid injections, stretching, medications, and PRP. You can also simply wait and see if the pain subsides spontaneously.  Surgery, as usual,  is the last option… and it will be a decision made by YOU, because you feel that your quality of life is limited to the point where you feel the potential benefits of surgery outweigh the potential risks of surgery (infection, stiffness, incomplete pain relief).

Treatment of Tennis Elbow with Bone Marrow (stem cell) Injections

Mayo Clinic Article on PRP for Tennis Elbow

Download this article from the American Ortho Society for Sports Medicine