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Tennis Elbow (Lateral Epicondylitis)
Lateral epicondylitis,
commonly known as tennis elbow, is a painful condition involving the
tendons that attach to the bone on the outside (lateral) part of the
elbow. Tendons anchor the muscle to bone. The muscle involved in this
condition, the extensor carpi radialis brevis, helps to extend and
stabilize the wrist (see Figure 1). With lateral epicondylitis, there
is degeneration of the tendon’s attachment,
weakening the anchor site and placing greater stress on the area. This
can then lead to pain associated with activities in which this muscle
is active, such as lifting, gripping, and/or grasping. Sports such
as tennis are commonly associated with this, but the problem can occur
with many different types of activities, athletic and otherwise.
The cause can be both non-work and work related. An
activity that places stress on the tendon attachments, through stress
on the extensor muscle-tendon unit, increases the strain on the tendon.
These stresses can be from holding too large a racquet grip or from “repetitive” gripping
and grasping activities, i.e. meat-cutting, plumbing, painting, weaving,
etc.
A direct
blow to the elbow may result in swelling of the tendon that can lead
to degeneration. A sudden extreme action, force, or activity could
also injure the tendon.
The most common age group
that this condition affects is between 30 to 50 years old, but it may
occur in younger and older age groups, and in both men and women.
Pain is the primary
reason for patients to seek medical evaluation. The pain is located over
the outside aspect of the elbow, over the bone region known as the lateral
epicondyle. This area becomes tender to touch. Pain is also produced
by any activity which places stress on the tendon, such as gripping or
lifting. With activity, the pain usually starts at the elbow and may
travel down the forearm to the hand. Occasionally, any motion of the
elbow can be painful.
Initially,
the activity causing the condition should be limited. Limiting the aggravating
activity, not total rest, is recommended. Modifying grips or techniques,
such as use of a different size racket and/or use of 2-handed backhands
in tennis, may relieve
the problem.
anti-inflammatory medications
may help alleviate the pain.
a tennis elbow brace, a
band worn over the muscle of the forearm, just below the elbow, can
reduce the tension on the tendon and allow it to heal.
may be helpful, providing
stretching and/or strengthening exercises. Modalities such as ultrasound
or heat treatments may be helpful.
A steroid is
a strong anti-inflammatory medication that can be injected into the area.
No more than (3) injections should be given.
A new type
of treatment, available in the office setting, has shown some success
in 50–60% of patients.
This is a shock wave delivered to the affected area around the elbow,
which can be used as a last resort prior to the consideration of surgery.
Surgery is only considered when the pain is incapacitating
and has not responded to conservative care, and symptoms have lasted
more than six months. Surgery involves removing the diseased, degenerated
tendon tissue. Two surgical approaches are available; traditional
open surgery (incision), and arthroscopy—a procedure performed
with instruments inserted into the joint through small incisions.
Both options are performed in the outpatient setting.
Recovery from surgery includes physical therapy
to regain motion of the arm. A strengthening program will be necessary
in order to return to prior activities. Recovery can be expected
to take 4–6 months.
The muscle involved in this
condition, the extensor carpi radialis brevis, helps to extend
and stabilize the wrist
© 2007 American Society for Surgery of the Hand
Developed by the ASSH Public Education Committee
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MedlinePlus®
National Library of Medicine
National Institutes of Health
lateral, epicondylitis, tennis, elbow
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