Tennis elbow is a condition that ranges from a simple inflammation of two of the tendons in the elbow (extensor Carpi radialis brevis ECRB and the extensor carpi radialis longus ECRL) to an actual tear within the tendon.
What Causes Tennis Elbow?
Tennis elbow is caused by repetitive use that strains the ECRB and ECRL. These two tendons extend the wrist. Patients with tennis elbow experience pain with wrist extension. Activities like lifting a jug of milk or lifting a cup of coffee may cause discomfort in the area of the elbow. In tennis players it may occur from poor technique, a cracked racquet frame or using a racquet that is too stiff with excessive power.
The Anatomy of Tennis Elbow
The ECRL and ECRB are two tendons that both originate on the lateral epicondylitis region of the elbow. That is the bone that you can feel on the outer half of the elbow. The two tendons travel down the arm and attach to two bones in the wrist and hand. Their function is to pull the wrist and hand upward for extension. Where the two tendons attach to the lateral epicondyle (the bone at the elbow) there is a poor blood supply. The limited blood supply makes it very difficult for the body to heal or resolve the tendinitis once it occurs. It also makes the condition more likely to occur repetitively.
Treatment Options for Tennis Elbow
Treatment for tennis elbow ranges from medication and stretching to surgery. The first line treatment for tennis elbow involves a series of stretches. The stretches include the pronator muscle/tendon, ECRB and ECRL. The stretches should be performed at least 3 times per day. Your doctor or physical therapist can prescribe the exercises. YouTube can also be a resource for demonstration of the exercises.
The use of a tennis elbow band is very important. Any brand band will work. It should not be a sleeve that goes around the elbow but a band. The band should be worn 24 hours a day, seven days a week for a total of six weeks. The band can be taken off for personal care such as showering. The band functions to change the origin site of the two tendons allowing the inflammation to resolve. The tennis elbow band is a critical part of the treatment.
The next part of the treatment plan is optional. Some people will benefit from the use of an anti-inflammatory medication. Consultation with your healthcare provider is necessary before taking any medication. To reach a Kentucky orthopedic, feel free to contact Dr. Grossfeld at Orthopaedic Specialists at 502-212-2663.
On occasion a cortisone injection may be given to the area of the inflammation. The cortisone is a super strong anti-inflammatory medication that helps to reduce the inflammation. There are several issues with cortisone injections given from the condition of tennis elbow (lateral epicondylitis). The first issue is that it gives immediate relief which may allow the person the get back to the sport quickly and cause the condition to immediately return.
Because the injection is given very close to the skin, and not in a joint, it may cause a whitening of the skin called Vitiligo. The skin may become very white and loss of the normal subcutaneous fat may occur causing the lateral epicondyle area to look very odd. Typically the skin will return back to its normal color within 12 months and the fat will re-populate during that same time frame.
There are several experimental forms of treatment that are also available ranging from PRP (platelet rich plasma) injections to Prolotherapy which may help to reduce the symptoms.
If all fails then a MRI scan is recommended. An MRI will help to identify if there is any interstitial tearing within the tendons or if the tendon has completely torn off the bone. In these cases surgery is indicated. The surgical procedure is outpatient and takes about 30 minutes to reform. It involves respecting the unhealthy and torn tendon and attaching to the lateral epicondyle.