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

Non-Operative
The first step in treating lateral epicondylitis is to eliminate the activities that cause or make your 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 healthcare 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 healthcare 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.