The elbow is a joint made up of three bones: the upper arm bone, the humerus, and the two forearm bones, the radius and ulna. The lower end of the humerus has bony prominences called epicondyles that serve as sites of attachment for major tendons and muscles that help with arm movement. The prominence on the outside of the elbow is called the lateral epicondyle. It helps in the attachment of the tendons and muscles that help extend your fingers and wrist.
What is Tennis Elbow?
Tennis elbow is a common name for the elbow condition lateral epicondylitis. It is typically an overuse injury that causes microtearing and degeneration of the tendons that attach to the lateral epicondyle.
Tennis elbow is a painful condition occurring from repeated muscle contractions at the forearm. The condition is common with sports activities such as tennis, painting, hammering, typing, gardening and playing musical instruments.
Tennis elbow and golfers elbow are similar, except that golfers elbow occurs on the inside of the elbow and tennis elbow occurs on the outside of the elbow.
Causes of Tennis Elbow
Tennis elbow is usually caused by overuse of the forearm muscles but may also be exacerbated by direct trauma such as with a fall, car accident or work injury.
Tennis elbow is commonly seen in tennis players, hence the name. Other common causes include any activity that requires repetitive motion of the forearm such as painting, hammering, typing, raking, weaving, gardening, lifting heavy objects and playing musical instruments.
Symptoms of Tennis Elbow
The signs and symptoms of tennis elbow can include the following:
- Pain on the outside of the elbow
- Pain that radiates to the forearm and wrist with grasping objects
- Weak or painful grip
- Pain in the elbow that is exacerbated when the wrist is bent back
Diagnosis of Tennis Elbow
Your doctor will evaluate tennis elbow by reviewing your medical history and performing a thorough physical examination. X-rays or advanced imaging may be necessary.
Treatment of Tennis Elbow
If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend a surgical procedure called lateral epicondyle release surgery. Your surgeon moves aside soft tissues to view the extensor tendon and its attachment on the lateral epicondyle and then trims or releases the degenerated portion of the tendon. Any scar tissue present will be removed and the bone may be debrided as well to stimulate healing.
Conservative Treatments for Tennis Elbow
Your physician will recommend conservative treatment options to treat the tennis elbow symptoms. These may include:
- Limiting use and resting the arm from activities that worsen symptoms.
- Splints or braces may be ordered to decrease stress on the injured tissues.
- Place ice packs on the elbow to reduce swelling.
- Avoid activities that tend to bring on the symptoms and increase stress on the tendons.
- Anti-inflammatory medications and/or steroid injections may be prescribed to treat pain and swelling.
- Occupational therapy may be ordered for strengthening and stretching exercises to the forearm
- Pulsed ultrasound may be applied to increase blood flow and promote healing to the injured tendons.
Lateral Epicondyle Release Surgery
If conservative treatment options fail to resolve the condition and symptoms persist for 6 - 12 months, your surgeon may recommend a surgical procedure to treat tennis elbow called lateral epicondyle release surgery. Surgery is considered a last resort and is typically only required in 1 in 10 patients. The surgical success rate for relieving tennis elbow pain is 85-95%. The goal of tennis elbow surgery is to remove the diseased tissue around the outer elbow, improve blood supply to the area, and alleviate your symptoms.
This surgery is usually performed in an operating room under regional or general anesthesia on an outpatient basis as day surgery. An incision is made on the outside of your elbow. Your surgeon moves aside soft tissues to view the extensor tendon and its attachment on the lateral epicondyle. The diseased portion of the tendon will be exposed and excised. Any scar tissue present will be removed and the bone may be debrided or drilled to stimulate healing.The wound is then closed and a sterile dressing is applied. A splint may also be placed to limit stress on the operative area.
Risks and Complications of Tennis Elbow
As with any major surgery, tennis elbow surgery may involve certain complications such as:
- Allergic reactions to medications
- Blood loss
- Nerve damage
- Radial nerve damage, causing numbness, tingling, burning or loss of feeling in the back of the hand and forearm
- Wrist weakness with extension
- Recurrence or failure of relief from symptoms
- Open Elbow Surgery
- Distal Biceps Repair
- ORIF of the Humerus Fractures
- Radial Head ORIF and Replacement
- Common Extensor Tendon Origin Repair
- Total Elbow Replacement
- Elbow Arthroscopy
- ORIF of the Coronoid Fractures
- Elbow Ligament Reconstruction
- Elbow Tendon and Ligament Repair
- UCL Reconstruction (Tommy John Surgery)
- Tennis Elbow Surgery
- Ulnar Nerve Release
- Ulnar Nerve Transposition
- ORIF of the Distal Humerus Fractures
- ORIF of the Olecranon Fractures
- Ulnar Collateral Ligament (UCL) Repair with Internal Brace