What is this burning pain on the side of my elbow?
A burning pain on the side of your elbow is commonly the result of Tennis Elbow (Lateral Epicondylitis).
What is Tennis Elbow?
Tennis elbow, or Lateral Epicondylitis, is a very common condition which falls under the broad category of something we called Tendinopathy. Simply stated, the tissues or tendons along the side of our elbow are changing as we age and are breaking down. This is very similar to the front of your favorite pair of blue jeans. You are going to look down one day and see a hole in the front of your pants. You didn’t do anything to cause that, other than wear them quite often. The tendons in our body are not very different. Tendinosis is a very common condition throughout our body. Tendinosis is simply the degeneration of a tendon, where if we took a look at it microscopically we would notice that it looks different than the normal tendons within your body. While tendinosis is quite common, if not always painful. We do not know why certain people with tennis elbow have pain yet others who also have tendinosis, do not have pain. So when I am asked, what is tennis elbow? — my answer is a degenerative condition affecting the tendons on the side of your elbow leading to pain when you are trying to lift an object. Why does it hurt when you are trying to lift an object? the tendon or muscle that is affected by tennis elbow is one of the muscles that control your wrist. Therefore, if you try to lift an object, particularly with your palm facing down, you will experience a burning occasionally sharp pain on the outer lateral side of your elbow. That is a classic presentation for tennis elbow.
What is the cause of tennis elbow?
As previously mentioned, tennis elbow is caused by a degeneration of the tendons or muscles on the side of your elbow. The cousin of tennis elbow, or golfers elbow, is a similar condition affecting the inner or medial side of your elbow. To a large degree the integrity of your tissues as we age is related to your genetics. Something else you can thank your parents for. Many patients have tendinosis of the elbow and don’t even know it. They usually presented the office either following a long weekend of activity or with a history with this slowly increasing pain along the side of their elbow which is now making it difficult for them to lift and move certain objects.
What do I do when I notice the symptoms of tennis elbow?
Luckily, in most cases your symptoms will simply go away on their own. Recent literature has actually shown that moist heat is better than ice. Certain stretches (video of exercise here) might improve your symptoms. Compression braces may improve your symptoms. And of course an occasional Advil or anti-inflammatory, if you are able to take them and understand the risks of taking them, may be of benefit as well.
When do I see a doctor for my tennis elbow?
Persistent pain. Tennis elbow, like most of the many over-use injured patients I see in my office everyday – may have a minimal impact on your activities — or a very significant impact. This really comes down to your quality-of-life. There is nothing structurally wrong with your elbow. If not going to fall apart. You’re not going to make it worse by using it. In managing you activities with tennis elbow, pain should be your guide. If you have tried the aforementioned measures for a week or two and your symptoms have not improved and they are starting to impact upon your quality-of-life – – – then it is time to see your doctor.
what are the treatment alternatives for tennis elbow?
Once you have seen an orthopedist, and your diagnosis is confirmed, a treatment plan should be arrived at. That treatment plan should really be geared towards the severity of your symptoms and the impact they are having on your quality-of-life. This is something I’ve frequently referred to as the personality of an injury. Your symptoms may be far less or far more severe than other patients presenting with tennis elbow. The treatment suggested will be geared towards improving your level of comfort. Options include further rest, wrist splints, moist heat application, physical therapy, injections, and perhaps regenerative techniques or surgery.
Many surgeons utilize cortisone injections as an initial treatment for patients suffering from tennis elbow. I do not necessarily recommend that. There has been a fair amount of recent research and literature which has shown that this can further damage the tissues on the side of your elbows – and can even lead to damage to the ligaments lying just beneath the tendons that are affected. The last thing the world you want is a painful, unstable elbow. Current recommendations are that you never exceed two or at most three injections around the elbow. What does cortisone actually do? We’re not exactly sure. Since this truly is not an inflammatory condition, we are not exactly sure why cortisone works to temporarily alleviate your symptoms. Unfortunately in the vast majority of cases, the improvement realized by the injection, is short-lived.
In recalcitrant cases, that is in patients where symptoms persist despite all the aforementioned measures, and if the pain from your tennis elbow is significant, either regenerative medicine, or surgical intervention is generally considered.
PRP or platelet rich plasma for tennis elbow.
PRP, although somewhat controversial, has been shown to benefit a significant number of people suffering from tennis elbow. PRP injections for tennis elbow is an office injection or procedure that starts with us drawing blood from your un-involved arm. We then place that sample of blood into a centrifuge and after the blood has spun in the centrifuge for a while certain layers will appear. One of those layers contains the PRP, or platelet rich plasma. PRP, or platelet rich plasma is a portion of your blood that contains cells called platelets and a concentrated liquid, which contains a number of chemicals that our body uses to regenerate itself. Contained within the platelets themselves is a very high concentration of these very same chemicals or growth factors. The idea behind PRP is that by placing these injections at the site of tendon degeneration, we can get your body to attempt to regenerate itself. This is vastly different than the cortisone injections we discussed previously. PRP, if successful, generally results in long-lasting relief – because the degenerative tissue, which was wearing out has started to regenerate or regrow itself. Once your blood is removed from the centrifuge, and the PRP layer is removed, it is injected into the area responsible for your tennis elbow symptoms.
Keep in mind this is a very active area of research within the orthopedic community. Not all PRP is created equal, there are different preparation techniques, they’re a different delivery techniques, and we are still perfecting the best method to be utilized to treat your tennis elbow. That being said, the results for PRP injections for tennis elbow have been quite promising.
Surgery for tennis elbow
The definition of a small surgery is surgery on someone else. That being said, the procedure to alleviate your pain because of tennis elbow is considered a relatively small procedure. The area involved on the outer side of your elbow is always in exactly the same place. This requires a relatively small incision, or an arthroscopic approach, where we simply clear out the degenerative tissue and then repair the normal tissue over the small hole that we left. The success rate of the surgery is very high, perform properly, the risk of the surgery is very low. As in most orthopedic situations, we are treating pain. Therefore, we are treating a patient and not their MRI findings. It doesn’t matter that your MRI shows evidence of tendinosis if you do not have severe pain. The only reason to consider surgical intervention is if other treatments, including the possibility of PRP injections, have failed – and your quality of life is poor.
If you live in Dutchess or Westchester counties in New York, and suffer from severe tennis elbow, and you would like to review your evidence-based treatment alternatives. Please feel free to click on the schedule an appointment button or simply call us at 914.789 – 2735 for an appointment.