Lateral Epicondylitis

What is it?

Lateral epicondylitis is a painful elbow condition that commonly occurs in people after the third decade of life. While it is called "tennis elbow", it occurs in any active person and is related to work, life and play. The condition occurs when small micro-tears occur in the muscles that originate from the outside of the elbow. Because the blood supply to these muscles is limited and because the injury can occur from so many daily activities, the repair process is often incomplete. When the repair process is incomplete, chronic inflammation occurs which is painful.

What are the symptoms?

Usually, the condition occurs slowly and may not be related to a single traumatic event. It can be related to overuse. Most commonly, patients have pain over the outside of the elbow.

How is it evaluated?

In general, the diagnosis is made by history and physical examination. Occasionally, regular radiographs (x-rays) are necessary. In more complicated situations, an MRI may be recommended by your physician.

How is it treated?

Non-surgical treatment strategies are effective for this condition and should be the mainstay of the treatment program. We recommend that treatment begin by instituting changes that are likely to be effective and have low risk. If these treatments are unsuccessful, then additional treatment alternatives will be discussed.

Treatments that HAVE BEEN shown to be effective:

  • Rest and avoidance of the activity that caused the symptoms
  • Use of a counterforce brace or other splint
  • Stretching exercises and then when the condition improves strengthening exercises
  • Externally applied modalities (heat in the morning and ice in the evening)
  • Equipment modifications
  • Non- steroidal anti-inflammatory agents
  • Occupational therapy (including modalities)
  • Corticosteroid injections
  • Surgery

Treatments that have HAVE NOT been shown to be effective

  • Magnets
  • Laser light treatment
  • Serum injection
  • Extracorporeal shock wave therapy (ECSWT)

Almost all patients experience significant improvement with proven non-surgical treatment strategies. You may have to make significant modifications in your daily activities (at home work and play). To improve, you will need to do stretching exercises. The treatment is usually a "tiered" program that starts with the more simple methods of treatment. Usually you'll be seen in the office at 4 to 6 week intervals to check on your progress and make adjustments to the program. Eight to 9 people out of ten gain satisfactory improvement with the non-operative treatment program. Diseases such as fibromyalgia, diabetes mellitus, and rheumatoid arthritis are associated with a poorer outcome.

Exercises

Once under the care of a physician, patients may be referred for physical/occupational therapy. The therapist will instruct patients on the proper way to perform exercises that can be done at home. The modified Mills exercises are designed to slowly stretch the muscles of top of your forearm. The exercises need to be done at least 4 times a day for 3-5 minutes at a time. All stretching exercises should be done slowly and held at the end of the stretch to ensure that the muscle groups are maximally stretched. Some patients need to apply heat prior to stretching and will need to use ice for 10 – 15 minutes after stretching.

Surgery

Because most patients improve with the non-surgical strategies we suggest that you pursue these alternatives for at least 6 months. If you do not experience enough improvement after 6 months of non surgical treatment, then surgery is a reasonable alternative treatment.

At the time of surgery, the degenerated tendon is excised and repaired to the bone. For the surgery to result in significant symptom improvement, the repair needs to heal securely to the bone. After surgery, we use a program of occupational therapy to allow elbow range of motion but protect the repair site. 8 out of 10 patients have significant improvement in their discomfort after this surgical procedure.