Orthopedic surgeons’ guide to tennis elbow

As sports medicine orthopedic surgeon, you may often see patients with complaints at their elbow – one of the more common diagnoses is tennis elbow, also known as lateral epicondylitis. Heads up: most patients with this condition might not even play tennis.

Tendons are the ones that hold muscle to the bone and tendons in our bodies are very tough and stretchy, kind of like rubber bands, but like rubber bands, they can weaken over time. Wear and tear on these tendons as we go about our daily activities can eventually lead to micro tears, and instead of being a smooth bundle of stretchy fibers, the tendons become “tangled” by the process of tearing and re-healing. If it leads to inflammation of the tendons, at the outside of the elbow, a part of the body called the epicondyle, it’s called epicondylitis, or tennis elbow.  This condition can occur in men or women. Anyone over the age of 40 is more at risk, with the likelihood rising as people age. As you must know, most people have not only a dominant hand bu a dominant arm. Since this arm is used for tasks more often, this is the arm most likely to fall prey to tennis elbow.

The most important treatment advice for healing and preventing the recurrence of tennis elbow is slow, steady, and most importantly consistent healing. Repetitive re-injury of inflamed tendons leads to the kind of scarring that can make tennis elbow very hard to eliminate.

Here you can find some examples of the types of exercises and non-invasive treatments that are often recommended:

• If the inflammation and tenderness are mild, a course of rest and NSAIDs (non-steroidal anti-inflammatories such as ibuprofen) may be adequate. Preventing tennis elbow before it takes hold is always the best plan of action.
• Physical therapy can also be a good way to deal with tennis elbow. Exercises which increase forearm strength and provide support for the tendons at the epicondyle will help reduce strain and inflammation. The “Tyler Twist” exercises are a great example of this, as they exercise muscles which don’t typically get a lot of use, providing better support for the elbow and its tendons.
• Steroidal injections at the epicondyle can help reduce inflammation, and thus pain, and allow efficient blood flow to resume, promoting the body’s natural healing processes. However, some studies show that while there may be short term relief, there may be a negative effect beyond that. For that reason, some doctors avoid giving these altogether.
• Platelet-rich plasma or PRP injections are injections of plasma spun down from the patient’s blood. The platelets and this the concentration of growth factors are thought to speed up the healing process.
• A new type of treatment gaining traction is that of shock wave therapy, which uses sonic waves at the site of pain and inflammation. While studies are still being done about the effectiveness of this treatment, and how exactly it helps with tennis elbow, there is some evidence that it can be good therapy, perhaps in concert with other more traditional treatments.

If some reason there is no improvement with the treatments above, advanced imaging such as an MRI may be required to identify the extent of the injury to the tendon. At this point, surgery may be the only option. This type of surgery is called open debridement, where the surgeon makes a small incision on your arm just below the epicondyle and carefully dissects down until they can see the point where the ligaments attach to the bone and muscle. Broken down tissue and scarring can be seen as slightly greyish tissue, compared to the pure while of the ligament, and the diseased tissue is cut away to allow the ligament to heal more cleanly, thus reducing future irritation, swelling, and pain the epicondyle.