Lateral epicondylitis (also known as tennis elbow) is a condition that most often develops from overuse. And while tennis players are intimately familiar with it, it can result from just about any repetitive motion of the hand, fingers, or wrist. If you use your forearm muscles a lot throughout the day (plumbers, painters, auto-mechanics, carpenters, chefs, house or office cleaners), you are more at risk for developing this very common condition.
So what is tennis elbow? For starters, your elbow consists of three bones: the humerus (which is your upper arm bone), the radius and the ulna (forearm bones). The bottom part of the humerus has two bony parts that you can feel on the inside and outside of your elbow. These are called the medial and lateral epicondyles. The forearm muscles and tendons attach to these epicondyles. In tennis elbow, it is the extensor tendons that attach to the lateral epicondyle that are damaged and cause pain.
The pain associated with tennis elbow starts when overuse of the muscles leads to microscopic tears of the tendons where the they attach to the lateral epicondyle. The body tries to heal these injured tendons but the blood supply to this area is relatively poor. As a result, the tendons degenerate from the inside out. Think of it like a rotten piece of fruit – it might be ok on the outside, but the inside is not. This degenerative area of tendon is referred to as the “Nirschl lesion” named after Dr. Nirschl who first described this problem.
Tennis elbow is one of a large number of tendon problems that develop mostly in middle age patients. It usually resolves on its own, but it can last for an extended period of time and result in a significant loss of productivity at work, at home or in sports.
So how do we treat tennis elbow? There are many conservative treatment options; however, most often your symptoms will resolve with time. It can take several weeks or up to several months for your symptoms to resolve. Several ways to help your symptoms are rest, activity modification (lifting with your palm up), anti-inflammatories, ice and a counterforce brace. Transverse friction massage has also been found to help as well. To do this, find the spot on the outside of your elbow that hurts the most and rub laterally until it basically brings tears to your eyes. This stimulates a healing response to the damaged tendon. Many times patients ask if a cortisone injection will help their symptoms but studies have shown that cortisone injections do not affect the prognosis of the condition. A cortisone injection may give you some relief initially for several weeks but soon your symptoms will return to how they were prior to the injection. If your symptoms are persistent for many months and you are frustrated with the pain, there are surgical options. A new option is a noninvasive procedure called Tenex Health TX that we have discussed in a previous post.
Overall, tennis elbow is a common type of tendonitis in the elbow that usually goes away with time but can be managed many different ways. If you have been complaining of similar symptoms as mentioned above, give us a call to make an appointment and let us help you determine the best treatment options for you.