ateral epicondylitis, more commonly known as tennis elbow, is one of the more common causes of elbow pain in athletes and non-athletes alike. It is thought to result from a small area of degeneration within a tendon on the lateral (outside) side of the elbow.
Who Suffers from This Problem?
Despite the injury’s being known as tennis elbow, many patients with lateral epicondylitis do not play tennis. People who play sports or regularly perform exercise using their arms, like golfers, can experience it. Manual laborers like carpenters and mechanics who use their arms for repetitive activities are often affected. Even adults who aren’t active can suffer this malady.
What Are the Common Signs and Symptoms?
A patient with tennis elbow often complains of pain on the lateral side of the elbow with use of the arm on that side. Pain radiating into the forearm can be present. Often activities requiring the extension of the wrist or rotation of the forearm increase the pain. As the problem progresses, the patient might complain of elbow pain at rest or at night.
How Does an Orthopedic Surgeon Make the Diagnosis?
Often history and physical exam alone can reveal lateral epicondylitis. The physician can re-create the pain with certain tests that cause discomfort just off the bony prominence on the outside of the elbow. Pain in that area while the patient extends the wrist and the physician applies resistance is a common finding that suggests lateral epicondylitis. X-rays often reveal no abnormality but can rule out other elbow injuries. Occasionally an MRI can reveal changes within the tendon.
What Are Some of the Nonoperative Treatment Options?
It is thought that a large percentage of patients with lateral epicondylitis improve over time without treatment. In fact, a recent study showed that 83 percent of patients with tennis elbow for more than six weeks recovered within one year without treatment.
A counterforce strap or brace worn over the affected area might relieve pressure on the involved tendon. Physical therapy for muscle strengthening and modalities like ultrasound are often prescribed as well. Corticosteroid injections (cortisone shots) into the area have been used as treatment options frequently.
Are Cortisone Shots Recommended for Tennis Elbow?
Significant controversy exists about cortisone shots for this problem. This treatment was a first-line option for years. Some recent studies show that patients who receive cortisone shots have worse long-term outcomes than patients who don’t. Many orthopedic surgeons feel that patients get good pain relief with cortisone shots, while others worry that the steroid medication can weaken the tendon, with the pain often returning.
Is Surgery an Option?
In a small number of patients with tennis elbow, nonsurgical treatments fail to work. Surgery to expose and cut out the diseased portion of the tendon and stimulate bleeding and healing in the area can often provide good pain relief for patients with continued symptoms.
Tennis elbow can cause a nagging elbow pain that limits a person’s ability to perform activities of daily living. While symptoms from this problem often resolve with time, nonsurgical and surgical treatments do exist if you continue to struggle with this pain.
Dr. Geier is an orthopedic surgeon at Sports Medicine Specialists of Charleston and the medical director of East Cooper Sports Medicine. For more information, on Dr. Geier and his practice, visit www.sportsmedspecialists.com.