Lateral Epicondylitis (Tennis Elbow Surgery)
What is it?
Lateral epicondylitis, or "tennis elbow", is a common condition that afflicts the outside of the elbow. It can be a source of persistent pain and aggrevation and is typically triggered from overuse. Pain is often sharp and patients may feel as though they tore something in their elbow. When a patient overuses their arm, it triggers inflammation in the tendons of the forarm extensor muscles which all originate from a common point on the outside of the elbow called the lateral epicondyle. This leads to point tenderness in this region and pain that is worsened by certain activities.
What causes lateral epicondylitis?
The vast majority of lateral epicondylitis is caused by overuse. This can be caused by activities such as tennis (back-hands particularly) as its pseudonym, "tennis elbow", suggests. More often it is triggered by a particularly vigurous day of elbow use such as cleaning or gardening excessively. Manual laborers are also prone to aggrevation of their elbow from the repetitive nature of their jobs and the physical input it takes to complete them. However, once the inflammation is triggered, less vigorous activities can retrigger the pain and it can be difficult to break the cycle of inflammation.
What if conservative measures fail?
If therapy fails to provide adequate relief, then sometimes surgery can be considered. In general, greater than 90% of patients with lateral epicondyltis can avoid surgery with a combination of non-surgical treatments. Prior to surgery, an MRI may be ordered in order to ensure that a more significant tear is not present.
During surgery, the diseased portion of the tendon is removed. Usually this creates a small hole in the tendon which needs to be repaired. After surgery, a brace is used to protect the repair and this is followed by several months of progressive rehbilitation.
What are the risks of surgery?
Surgery for lateral epicondylitis is typically very safe. It is an outpatient procedure performed through a small incision by the lateral epicondyle. Other than general surgical risks and anesthetic risks, specific risks include:
- Stiffness
- Prolonged rehab
- Loss of strength
- Re-tear of the tendon
How do I know if I have lateral epicondylitis?
Patients with lateral epicondylitis of the elbow typically have point tenderness over their lateral epicondyle, the bony prominence on the outside of the elbow. Sometimes the pain radiates down the back of the forearm. It can also be worsened by use and cause a weak or painful grip. Physical examination is typically all that is needed to diagnose you with lateral epicondylitis, however, x-rays are often taken as well to rule out other sources of pain. Rarely, an MRI may be ordered to make sure there is not a significant tear or other reason for your pain.
How is it treated?
The vast majority of lateral epicondylitis can be managed without surgery. However, it can take months of treatment to attain complete relief. The goals of treatment are to break the cycle of inflammation at the lateral epicondyle. Below are some common methods used to achieve this.
Rest and activity modification: Avoiding activities that aggrevate the tendons at your lateral epicondyle is key. This usually means avoiding any repetitive motions involving extension of the wrist.
Ice: Ice can be helpful to decrease inflammation. Anecdotally, using ice to massage the region of imflammation and pain can be even more helpful.
Anti-inflammatories: Since lateral epicondylitis results from inflammation due to over use, anti-inflammatories (naproxen or ibuprofen) can be helpful. However, you must watch out for stomach irritation and it is not recommended for patients with kidney issues.
Physical Therapy: PT is aimed at stregthening and stretching the muscles of your forearm. Additionally, therapist may be able to offer additional modalities to promote healing of the tendon tissue that is inflammed.
Braces: Tennis elbow braces can help to off-load the stress at the tendon. In severe cases, a wrist brace can help support the muscles of the forearm. In general however, we discourage long-term reliance on braces since they do not promote strengthening to of the muscle and symptoms may return as soon as the brace is discontinued.
Injections: Steroid injections can be used if other conservative measures are unsuccessful. However, occasionally, injection of the tendon can lead to a tear of the tendon. Additionally, although the inflammation can be diminished with an injection, it does not directly promote any healing at the site of inflammation. PRP (platelet rich plasma) injections are another possibility which in theory can help to promote tendon healing, however, currently there is little evidence to prove that it is effective.
