Tennis Elbow

Tennis elbow is the common name for lateral epicondylitis. Tendons attach muscles to bone. Tennis elbow is a condition that affects the tendons that work with the bone on the outside of the elbow and with a muscle that works the wrist. The tendon's attachment loses its grip on the muscle when the condition is present, and grows weaker where it anchors on the bone, which leads to greater stress over the entire region.

When the muscle and tendon is used, pain is experienced. Although tennis is traditionally associated with the condition, it can show up after any number of activities, all of which are not athletic. Practically everyone is susceptible to this condition, regardless of age or gender, but it is most common in adults between thirty and fifty years of age

Trauma is a common cause for tennis elbow, and many cases result from a blow that makes the tendon swell and deteriorate. The tendon is also vulnerable to many extreme actions, forces, or activities, any one of which can injure it.

Tennis elbow can also be caused by overuse. The tendon associated with the condition can be strained through any activity that stresses its attachments. For example, activities involving gripping (e.g., grasping a tennis racket) and repetitive motion (e.g., weaving, painting, auto repair) can also create stress.

The most common symptom of tennis elbow and the one that most often leads to medical treatment is pain on the outside of the elbow. Not only is the area tender if touched, but any activity that puts stress on the tendon, any gripping or lifting, is painful. The pain that shows up usually runs down from the elbow to the hand, and presents itself when the elbow is moved. 

Treatment by your Beverly Hills plastic hand surgeon is broken down into two broad categories. The first of category doesn't involve surgery, which is usually an option when the more conservative approaches do not help. 

• Modifying Activity - If an activity causes pain, the best advice is simply not to engage in it. This, however, is not always an option, but attempts can be made to limit actions that aggravate the condition and this is typically more effective extended bed rest. If work or other activities can't be avoided, simply modifying your grip can relieve the problem. For example, when treating pain that is associated with a particular activity (e.g., tennis), using a different size racket or a two-hand backhand may be very helpful.

• Medication - The use of anti-inflammatory medications can lessen or eliminate the pain.

• Use of a Brace - A special band worn on the forearm, just underneath the elbow, can lessen tension on the tendon and help it heal.

• Physical Therapy - In addition to using treatments that involve heat, physical therapy aimed at stretching and strengthening the muscles can help.

• Injections of Steroids - Steroids, which are strong anti-inflammatory medications, can be injected directly into the elbow. Injections, however, should not be incurred too many times.

• Shockwave Treatment - This treatment, which can be conducted in your hand surgeon's office, is fairly new but is successful approximately 50% - 60% of the time. The treatment, itself, involves delivering a shock wave around the part of the elbow where the pain is greatest.

Surgery is never a first choice when treating tennis elbow. When the more conservative treatments have failed to help relieve the symptoms for over six months, or if the pain has become incapacitating, surgery may be the best choice. Your hand surgeon will remove the part of the tendon that has become diseased or degenerated, either through a traditional incision or through arthroscopic surgery (i.e., a procedure that makes use of smaller cuts into which instruments can be inserted into the elbow). Surgical treatment of tennis elbow is often conducted in an outpatient setting. 

To help the tendon heal, the recovery process will include physical therapy directed toward restoring arm movement. In order to resume activities that patients engaged in prior to the surgical procedure, part of the therapy will include a muscle-strengthening program. A full recovery may take between four and six months.