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Tennis Elbow: Causes, Symptoms, and Treatment

Updated: Jun 23

Written by Eric Balaguer, MD


Tennis elbow, also known as lateral epicondylitis, is a painful condition affecting the outer part of the elbow. Despite its name, it's not exclusive to tennis players. Anyone who repeatedly uses their forearm muscles, especially in activities involving gripping and wrist extension, can develop this condition.

CAUSES

Tennis elbow is primarily caused by overuse and repetitive strain of the tendons that attach the forearm muscles to the outer bony bump of the elbow. Microscopic tears develop in the tendon due to this repetitive strain, leading to inflammation and pain.


Common activities that can trigger tennis elbow include:

  • Racquet sports (tennis, squash, badminton)

  • Golf

  • Painting

  • Carpentry

  • Plumbing

  • Repetitive computer mouse use


SYMPTOMS

The hallmark symptom of tennis elbow is pain or burning on the outer part of the elbow. The pain may worsen with gripping objects, twisting motions, or lifting.


Other symptoms may include:

  • Weakened grip strength

  • Stiffness in the elbow

  • Pain radiating down the forearm


DIAGNOSIS

A doctor can typically diagnose tennis elbow through a physical examination and a discussion of your symptoms and activities. They may also perform tests to rule out other conditions that can cause similar symptoms, such as arthritis or nerve compression.


TREATMENT

In most cases, tennis elbow can be effectively treated with non-surgical methods. 80% of patients will have the symptoms resolve on their own within 6 months.


These may include:

  • Rest: Avoiding activities that exacerbate the pain is crucial for allowing the tendon to heal.

  • Ice: Applying ice packs to the affected area can help reduce inflammation and pain.

  • Pain relievers: Over-the-counter pain medications like ibuprofen or naproxen can help manage discomfort.

  • Physical therapy: Specific exercises can help strengthen the forearm muscles and improve flexibility, aiding in the healing process.

  • Bracing: Wearing a brace around the forearm can help reduce strain on the affected tendons.

  • Corticosteroid injections: In some cases, injecting corticosteroids into the affected area may be recommended to reduce inflammation but will not be beneficial to heal the tendon and, in most circumstances, once the cortisone wears off, the symptoms recur.

  • Regenerative Medicine: Platelet Rich Plasma, Amniotic Fluid and Stem cell injections are being used effectively to treat this condition.

    • PRP Injection: PRP is derived from a patient's own blood, which is processed to concentrate platelets. Platelets are rich in growth factors that play a crucial role in tissue healing and regeneration. Injection is very painful for several days.

  • Amniotic Fluid Injection: Amniotic fluid, the fluid that surrounds and protects a developing fetus, contains growth factors, cytokines, and other substances that can promote tissue repair and regeneration.

    • Reduce inflammation: Amniotic fluid contains anti-inflammatory cytokines that can help calm the immune response and reduce pain.

    • Stimulate tissue repair: Growth factors in amniotic fluid can encourage the growth of new cells and tissues, promoting healing.

    • Modulate scar tissue formation: Amniotic fluid may help prevent the formation of excessive scar tissue, which can impair tissue function.

  • Stem cell injection: Stem cells are unique cells that have the ability to differentiate into various cell types, potentially promoting tissue repair and regeneration.

    • Cost is very high

    • Invasive


If conservative treatments fail to provide relief, surgery may be considered.


SURGICAL OPTIONS:

  • Tenex: Ultrasound Guided ECRB tenotomy

    • Tenex is a minimally invasive procedure that utilizes ultrasonic energy to break down and remove damaged tissue within the tendon, leaving healthy tissue intact.

    • Success rate documented between 85-95%

    • Can be done in the office under local anesthesia


Shockwave Therapy:

  • Non-invasive treatment option for tennis elbow (lateral epicondylitis). It involves delivering high-energy sound waves to the affected area to stimulate healing and reduce pain.

    • The shockwaves create microtrauma in the tissue, which triggers the body's natural healing response. This process increases blood flow to the area, promotes the formation of new blood vessels, and stimulates the production of collagen, a key protein for tissue repair.

    • Shockwave therapy usually requires multiple sessions (3-5) for optimal results


Open Release of ECRB tendon Origin/Tendon Lengthening

  • Open surgical procedure to release or lengthen the ECRB tendon

  • Success rate 80-90%

  • Long recovery period


Tennis elbow is a frequent condition, which is very hard to treat. The key to this condition is complete healing of the ECRB tendon. Many times, this is very difficult to achieve. Most time it requires a combination of all the available treatment and significant amount of time for the tendon to fully heal and the pain completely resolves.

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