Tennis Elbow (Lateral Epicondylitis) Description Tennis elbow is a degenerative condition of the tendon bers that attach on the bony prominence (epicondyle) on the outside (lateral side) of the elbow. The tendons
involved are responsible for anchoring the muscles that extend or lift the wrist and hand
(see Figure 1). Risk Factors/Prevention Tennis elbow happens mostly in patients between the ages of 30 years to 50 years. It can occur in any age group. Tennis elbow can affect as many as half of athletes in
racquet sports. However, most patients with tennis elbow are not active in racquet
sports. Most of the time, there is not a speci c traumatic injury before symptoms start.
Many individuals with tennis elbow are involved in work or recreational activities that
require repetitive and vigorous use of the forearm muscles (see Table 1). Some patients
develop tennis elbow without any speci c recognizable activity leading to symptoms. Symptoms Patients often complain of severe, burning pain on the outside part of the elbow. In most cases, the pain starts in a mild and slow fashion. It gradually worsens over weeks
or months. The pain can be made worse by pressing on the outside part of the elbow or
by gripping or lifting objects. Lifting even very light objects (such as a small book or
a cup of coffee) can lead to signi cant discomfort. In more severe cases, pain can occur with simple motion of the
elbow joint. Pain can radiate to the forearm. To diagnose tennis elbow, tell Dr. Norberg your complete medical history. He and his team will perform a physi- cal examination. The doctor may press directly on the bony prominence on the outside part of the elbow to see if it causes pain.
The doctor may also ask you to lift the wrist or ngers against pressure to see if that causes pain. X-rays are not necessary. Rarely, MRI (magnetic resonance imaging) scans may be used to show changes in the tendon at the site of attachment onto the bone. Treatment Options In most cases, nonoperative treatment should be tried before surgery. Pain relief is
the main goal in the rst phase of treatment.
Dr. Norberg will tell you to stop or limit any
activities that cause symptoms. You may
need to apply ice to the outside part of the
elbow. You may need to take acetaminophen
or an anti-in ammatory medication for pain
relief. Orthotics can help diminish symptoms of tennis elbow. Dr. Norberg commonly recommends wrist splints. These can reduce symptoms by resting the muscles and tendons (see Figure 2). Frank Norberg M.D. Sports Medicine and Shoulder Specialist 3250 W. 66th Street Edina, MN 55435 Phone: 952-920-0970 Fax: 952-920-0148 Symptoms should improve signi cantly within four weeks to six weeks. If not, the next step is a corticosteroid injection around the outside of the elbow. This can be
very helpful in reducing pain. Corticosteroids are relatively safe medications. Most
of their side effects (i.e., further degeneration of the tendon and wasting of the fatty
tissue below the skin) occur after multiple injections. Avoid repeated injections (more
than two or three in a speci c site in a single year). After pain is relieved, the next phase of treatment starts. Modifying activities can help make sure that symptoms do not come back. Dr. Norberg will want you to
do exercises. This may include stretching and range of motion exercises and gradual
strengthening of the affected muscles and tendons (see Figure 3). Physical therapy
can help complete recovery and give you back a painless and normally functioning el-
bow. Nonoperative treatment is successful in approximately 85 percent to 90 percent
of patients with tennis elbow. Treatment Options: Surgical Surgery is considered only in patients who have incapacitating pain that does not get better after at least six months of nonoperative treatment. The surgical procedure involves removing diseased tendon tissue and reattaching normal tendon tissue to bone (see Figure 4). The procedure is an outpatient surgery; you do not need to stay in the hospital overnight. It can be
performed under regional or general anesthesia. Most commonly, the surgery is performed through a small incision over the bony prominence on the outside of the elbow. Recently, an arthroscopic surgery method has been developed and is indicated in speci c cases.
So far, no signi cant bene ts have been found to using the arthroscopic method over the more traditional open incision. After surgery, the elbow is placed in a bulky dressing and the patient is sent home. About one week later, the sutures and splint are removed. Then exercises are started to stretch the elbow and restore range of motion. Light,
gradual strengthening exercises are started two months after surgery. The doctor will tell you when you can return to
athletic activity. This is usually approximately four months to six months after surgery. Tennis elbow surgery is con-
sidered successful in approximately 90 percent of patients. A signi cant portion of people will continue to have mild
symptoms in the area after surgery. These do not typically restrict activities. 3250 W. 66th Street Edina, MN 55435 Phone: 952-920-0970 Fax: 952-920-0148