What is tennis elbow and how is it treated?

Transcript

Let's talk about tennis elbow surgery. Tennis elbow, or lateral epicondylitis, is an inflammation or tendinitis occurring at the outside of the elbow that can cause considerable pain. There are many activities that can cause this, but one of the most common, where it gets its name from, are tennis players hitting repetitive backhand, as seen with one of the top players in the world. Other activities that can cause this, repetitive keying on the keyboard all day or using the mouse. And finally, forceful activities such as swinging a hammer all day at the construction site.

So what do we do about this? Well, let's take a look at the overall pain pattern first. And the circle is the area denoting the bony prominence on the outside of the elbow where this pain can emanate from. It can actually radiate down the forearm a bit. It's increased with resisted extension of the wrist.

So let's take a look at the anatomy to understand this better. You can see the muscles, the wrist extensor muscles, come from up toward the elbow and go all the way down to the wrist. And it's in that circle area where the muscles originate from where you can get tears in the muscle, leading to this epicondylitis or painful condition. As you can see here, the lateral epicondyle, or outside of the elbow, is where that muscle originates from.

So let's take a look at the treatment for this. It's an overuse predominantly problem, so the first thing you want to do is rest the arm. Laying off the tennis, laying off whatever work activity or day to day activities precipitate it. Icing is key. Placing a lot of ice around the clock can reduce swelling and inflammation, particularly right when the symptoms start.

Palm up lifting. We ask the patient to lift with the palm up because that puts the stress on the inside of the elbow, letting those muscles rest, as opposed just to picking up a purse with a palm down, which can be very very painful. NSAIDs, nonsteroidal anti-inflammatory medication such as ibuprofen, can reduce inflammation and swelling.

Bracing is one of the most important things you can do for this condition. It's called a counterforce strap, or a tennis elbow brace, and it's this black band right here. This one's built into a sleeve, but many come just with that band. That band goes about three fingers below that bony prominence right here on the upper forearm. A lot of times they'll have a little pressure point. We want that pressure point right over the extensor muscles here. What that does is it clamps down on those muscles, and so the muscles think they're originating from where the brace is during activity, letting that damaged muscle behind the splint or brace hopefully heal.

If the brace doesn't do it, there's some other treatment options. Therapy is beneficial, particularly once the pain has subsided. We want to start strengthening those muscles. Finally, injections of Celestone or cortisone shot, and a PRP injection, those you'll see doctors using from time to time and they can be beneficial, but usually it's a short-term benefit and over the long haul they have not been proven to be successful. But they can keep you in the game and buy you some time. But overall we see this happening way too frequently, where you go into the doctor's office and they give you the injection right off the bat when all these other things likely will resolve the problem.

However, if all this conservative treatment doesn't work, surgery may be beneficial. So there's a 20 minute outpatient surgery where we go in and we open up that torn tendon. And you can see here we're cutting away the scar tissue that's formed, or granulation tissue, and then we're going to take this little burr and we're going to remove bone spurs, and then we'll put several little holes in the bone that will promote bleeding and hopefully allow this muscle to heal back to the bone.

After surgery we'll place you in a brace for about 3 weeks, that goes from the wrist all the way above the elbow, completely immobilizing the arm for about 3 weeks before beginning therapy. The total recovery time after this is about 3 months. The overall success rate is about 80%. For more on this condition and many other conditions, check out our website.