Tennis elbow, which is also known as lateral epicondylitis, is a very common problem. Individuals often complain of pain that originates over the outside (lateral) aspect of the elbow. Often, the pain can radiate up the arm and down the forearm with activities.
Tennis elbow is caused when the attachment of a tendon to the outside bone at the end of the humerus is irritated. This tendon attachment can degenerate over time and with normal wear-and-tear. In Orthopedics, doctors will refer to this degeneration as tendinosis. Unfortunately, tendinosis is often a natural part of the aging process and there is really no way to prevent it.
The tendons that attach to the outside of the elbow also cross the wrist. These tendons connect to both the wrist and fingers. Because of this, when you use your hand or wrist, it will often times also hurt your elbow. For example, if you grab a coffee mug or shake hands, it will hurt your elbow because they are all connected. It may not make sense to have elbow pain when you use your fingers, but it is common, and that connection is the reason the pain occurs.
The good news is that almost no one needs surgery for tennis elbow. The bad news is that it can take 90% of people 5-6 months to get over tennis elbow. It can be very frustrating as the pain occurs with almost any activity. The main stay of treatment is a bracing program. We usually recommend two different braces. The most important brace is a simple wrist brace (also called a carpal tunnel brace). It should be worn at night and during the day when the pain is more bothersome. The second brace is a tennis-elbow strap (also known as a counterforce brace). This is recommended anytime you are lifting or performing activities such as working out, yardwork or grocery shopping. We also usually recommend a visit to the occupational therapist to learn a simple home therapy program for conditioning and strengthening. Ice and anti-inflammatory medications can be used to help alleviate pain. Finally, it is important to check out the ergonomics of your workstation. When typing, your wrist and hands should be in a straight (neutral) position and not cocked up or down (extension or flexion). This can have a profound negative affect on your pain. If corrected, tennis elbow pain can get better much more quickly.
There is some controversy about treating tennis elbow pain with steroid injections. There have been numerous studies done comparing patients receiving steroid injections vs. those that did not receive the injections. In reviewing of all these studies, we don’t see the data to show that steroid injections are helpful long-term. In fact, because of that, many doctors have stopped giving steroid injections to patients with tennis elbow over the last 8-9 years. Often times we see patients do better without the injections. It is true that patients may feel good for a short period of time after the injection. However, sometimes the pain returns and is more severe, and it also may prolong the overall time needed to resolve the pain.
Finally, there is a lot of buzz regarding a new injection that we can offer. It is created from your own blood and it can have significant healing capabilities for tendon wear-and-tear (tendinosis). The way it works is that we draw a small amount of blood from the patient and spin it down using a machine. We then inject a part of that blood, now known as plasma following the spinning process, into the area of the lateral epicondylitis. The idea behind this is we are adding biology to a degenerative tendon. It is very safe and more effective than steroid injections. The only downside can be cost, as insurance companies many times do not cover the cost of the injection. However, it can be an extremely helpful tool when patients are trying to avoid surgery or reduce the time it takes until the pain gets better.
Dr Fagelman is an orthopedic surgeon who specializes in shoulder and elbow conditions at OrthoTexas. Tennis Elbow is one of the most common injuries that he sees in his office. Don’t live with the pain. There are many options available to help you feel better if you are experiencing pain in your elbow.