The elbow is a simple hinge joint connecting the upper arm to the forearm. The joint is very stable because of its bones which include the upper arm (humerus) and the forearm bones (the radius and the ulna). Several muscles cross the elbow joint to allow it to flex and extend. Some of these muscles also allow the wrist to flex and extend. In addition, the elbow is stabilized by ligaments on the outside (lateral) and inside (medial) elbow.

Lateral Epicondylitis (Tennis Elbow)

The elbow joint is made up of the bone in the upper arm (the humerus) and one of the bones in the lower arm (ulna). The bony prominences, or bumps, at the bottom of the humerus are called the epicondyles. The bump on the outer side of the elbow is called the lateral epicondyle.

Lateral epicondylitis is a condition that causes pain and tenderness at the prominence on the outer part of the elbow. The condition occurs as a result of overusing the forearm muscles that straighten and raise the hand and wrist. When tendinopathy, or fiber microtearing, occurs at the muscle origins at their point of attachment, the lateral epicondyle. Small tears in the tendon tissue can occur, and the muscles may strain and irritate their attachment at the bone. These muscles act to extend the wrist and allow lifting.

Causes

Despite the common name for lateral epicondylitis, tennis elbow, the condition can be caused by other activities besides playing racquet sports. Many commonplace activities can strain the tendons. Basically, any activity that twists and extends the wrist can lead to lateral epicondylitis. Rarely, a direct blow to the outside of the elbow can also lead to the condition.

Symptoms

• Pain or tenderness on the outer side of the elbow.
• Pain when the wrist or hand is straightened.
• Pain worsened by lifting a heavy object.
• Pain with making a fist, gripping an object, shaking hands or turning door handles.

Treatment

The type and duration of the treatment will depend on the severity of the condition, and other factors.

• Non-operative

The first step in treating lateral epicondylitis is to eliminate the activities that cause or make the symptoms worse. Activity modification should be attempted for at least six weeks to see if symptoms improve. Tennis elbow is thought to be self-limited, meaning that it often resolves on its own, given time. This has been supported by studies showing improvement over time.

Your health care provider may prescribe an anti-inflammatory medication to decrease pain.

Injections of steroid (cortisone), blood, or platelet-rich plasma (PRP) directly into the area may also be an option.

Treating the area with an ice pack, performing an ice massage, and stretching are also recommended.

A tennis elbow strap, or counterforce brace, may be worn just below the elbow to provide support to this area.

If these methods do not help, your health care provider may also send you for a course of therapy. Your therapist will instruct you on exercises designed to strengthen the forearm muscles.

• Operative

If the condition does not respond to the above treatments for an extended time period, surgery may be necessary. The surgery is usually performed on an outpatient basis. An incision is made on the outside of the elbow, and the surgeon will explore the tendons and may remove tissue that has degenerated. He or she may have to cut the tendon at its attachment to the bone, and remove a small portion of the bone to improve the blood supply to the area.

Ulnar Collateral Ligament Tears

Once thought to be career ending, ulnar collateral ligament (UCL) tears are now able to be diagnosed and usually treated at an early enough stage so that overhead athletes – pitchers, volleyball players, swimmers – can return to their sports and compete at a high level. The problem has evolved since the original description of it and since it was popularized by the 'Tommy John' surgery performed in Southern California.

Tearing of the ligament usually occurs following some localized soreness of the elbow on the inside. The actual tear is often felt as a ‘pop’ and athletes are usually unable to continue after it occurs. Though there is likely a continuum of injury severity, when a ‘pop’ is felt surgical repair is usually necessary to allow full competitive return to sports. The surgery is done on an outpatient basis using either a tendon from the arm or leg via an open procedure. Many surgeons perform an arthroscopy first to check for associated problems which may exist and take care of them at the same time.

Following surgery, bracing for several weeks and a slow progressive rehab is important to allow for a successful outcome. Overhead motions and throwing are possible at three months and competition is allowed between six and nine months