Tennis Elbow

Profiled condition: Lateral epicondylitis (Tennis elbow)

Definition: what is it?

This is a degeneration and inflammation of the tendons that attach to the outside of the elbow. It occurs with repetitive use of the elbow. The strength and flexibility of your muscles and tendons are unable to withstand the work you are giving them. The work you give them may be light, as it is in typing, but you may be typing for hours on end and this overloads the muscles and tendons beyond their capacity.

You can also get this injury from a very heavy one time strain. For example say you are getting off an airplane. Your right hand is full, so pull your luggage down from the overhead baggage compartment with only your left hand. As soon as the luggage makes it over the edge of the rack a tremendous strain goes on your left elbow tendons. This may be all it takes to get tennis elbow.

Tennis elbow is so named because tennis players get this problem from the back hand stroke but it is much more common in people that use their hands and arms repetitively.

If the tendons on the inside of the elbow are injured this is called Medial Tennis Elbow or Golfer's Elbow. Generally speaking the same therapies described here for Lateral Tennis Elbow are also used for Medial Tennis Elbow with some variations.

What does it feel like to have this condition?

You have pain at the lateral side of the elbow. Sometimes the pain extends upwards al few inches above the elbow and it may also extend down into the forearm towards the wrist. The pain is worse with repetitive movements of the elbow. You may also lose grip strength.

Long standing cases of Tennis elbow are a risk for a complicating condition in which the nerves at the elbow get pinched. This may result in numbness and tingling in the forearm and hand and weakness in the hand.

How do we diagnose this condition?

Tennis elbow is easily diagnosed by asking you questions (history taking) and with a physical examination of the painful area.

We perform range of motion and orthopedic tests during this examination. There are specific orthopedic tests called tennis elbow tests that we do.

In certain cases we may take x-rays to rule out any problems in the nearby joints.

We may also order an MRI to rule out a more severe muscle tear or a nerve or joint injury

Our treatment

1. We treat Tennis elbow by removing the strain temporarily (resting) and then rebuilding the injured muscles and tendons so they are now able to handle the activities you desire. To rest the area and remove some of the strain we use a very narrow brace around the elbow that restricts the force that the injured muscles and tendons can pull with and yet allows the elbow to move freely.
2. Simultaneously with rest we help the area heal by using ice, ultrasound and massage therapies. These treatments reduce the inflammation in the area and bring fresh blood that will clean up the injured cells in the injured muscles and tendons.
3. We also use High Voltage Electrical Stimulation: this gentle modality diminishes pain and promotes healing. This technique has been recommended by elbow surgeons as an effective non- surgical treatment.
4. Chiropractic adjustments of the elbow may be performed if the elbow joints are stiff. This joint stiffness often is an underlying factor that keeps the muscles and tendons in the area from healing.
5. As the pain starts to subside we give a series of exercises to strengthen the tendons. The exercises use light dumbbells. It is important to continue these exercises well beyond the time that you feel no pain at the elbow. As stated previously, this prevents re-injury.
6. Also in the healing stage we use a deep form of massage called cross fiber friction (link here) this helps the healing process by diminishing the amount of scar tissue in the healing tendons.
7. It is important to understand that to fix or cure this problem you must rehabilitate the muscles and tendons to their pre-injury state. In fact you must make them stronger than they were before you got injured if you want to be able to resume your activities and not get re-injured.

Other treatments for Tennis Elbow

1. Oral medications
2. Cortisone injections are sometimes used in severe cases. This does help reduce inflammation and pain, but it also weakens the connective tissues around the elbow. Therefore cortisone injections must be given sparingly.
3. Surgery is usually reserved for failures of rehabilitation (greater than 1 year of high quality rehabilitation) or 3 or 4 more cortisone injections.

If you would like to receive a free telephone consultation from Dr. Schwartz about Tennis Elbow elbow please call us at (732) 698-7151.

Dr. Schwartz has been treating patients from East Brunswick, Old Bridge, Spotswood and Monroe Township for the past 14 years.

References

1. Morrey BF: The elbow and its disorders., ed. 3, pgs 526-529, Philadelphia, W.B. Saunders, 2000.
2. Nirschl, R.P.: Arm Care. Arlington, VA, Med. Sports Pud., 1983
3. Nirschl, R.P., and Sobel, J,: Conservative treatment of tennis elbow. Phys. Sports Med. 9:42, 1981.