The elbow joint is made of three bones: the two forearm bones (the radius and ulna) that connect with your upper arm (the humerus) to create the elbow joint. The forearm muscles, ligaments and tendons hold the elbow joint together and control movement of the elbow, wrist and hand.
The forearm muscles run down to and operate the wrist and fingers. Forearm tendons attach the forearm muscles to the bone at the lateral epicondyle at the outside of the elbow and the medial epicondyle at the inside of the elbow. Tendons carry the force of muscle action to the bone, creating movements.
What is tennis elbow?
Tennis Elbow (lateral epicondylitis) is tendonitis of Extensor Carpi Radialis Brevis (ECRB) muscle in the forearm. The ECRB functions to stabilize the wrist when the elbow is straightened. Overuse causes pain and inflammation and weakens this tendon – muscle complex.
Cumulative and on-going repetitive trauma from overuse strains the tendons resulting in pain, inflammation, and muscle tenderness on the outside of the elbow that can spread to the forearm and wrist.
Tennis elbow can affect one or both arms and usually involves the dominant arm. It is estimated to affect 1-3% of the population, and up to 10% of women. 10-50% of tennis players aged 30 to 50 develop tennis elbow, however you don’t need to play tennis to get tennis elbow! Most patients respond well to conservative measures but about 10-15% will need surgery.
What causes tennis elbow?
The primary cause is a too tight of a grip. Overuse can occur with any activity that requires a strong handgrip including sports like golf, baseball, bowling, tennis and racquet ball, and gardening. Occupational activities that require constant arm, elbow and wrist work include craftsmen, mechanics, carpenters, butchers, cooks and auto workers. Tennis elbow can cause disability, limit activity and interfere with work.
Overuse causes inflammation, swelling and pain. Chronic strain creates microscopic tears in the tendon which slowly degenerates the tendon.
- Pain when flexing the wrist.
- Pain and tenderness over the epicondyle.
- Pain that runs from the outside of the elbow down to the wrist.
- Painful handshakes, turning and squeezing motions.
- Pain when gripping tools or utensils
- Wrist weakness and a weak grip.
- Pain that worsens with activity and may be relieved with rest.
How is it diagnosed?
Your Ortho Illinois orthopedic surgeon can often diagnose the condition by considering your symptoms, occupational risks, and recreational activities. They will perform a physical examination and may confirm a clinical diagnosis of tennis elbow with x-rays, ultrasound and other imaging to rule out other potential conditions such a fracture.
Initially, conservative treatments are recommended to relieve pain and inflammation.
Conservative treatment includes:
- Rest and activity modification
- Anti-inflammatory medications for pain
- A forearm strap can reduce tension on the tendon and relieve pain, and a night splint can help to rest the muscle
- Steroid injections
- Avoiding any activity that causes or aggravates pain
- Physical therapy with stretching and strengthening exercises, heat and ultrasound treatments.
The vast majority of patients with this condition will improve and recover with conservative treatment. However, PRP and ESWT have been shown to provide additional pain relief, improved function, and faster recovery. Discuss all your options with your Orthro Illinois surgeon.
Platelet Rich Plasma (PRP)
PRP may help to enhance soft tissue regeneration by releasing growth factors that modulate the inflammatory response. It is safe and effective to stimulate tendon and ligament healing which provides long-term pain relief and function improvement. PRP is created from your own blood so there is no risk of complications and no side effects, unlike steroid injections that can further degenerate the tendon.
Extracorporeal Shockwave therapy (ESWT)
ESWT is noninvasive and has been reported to provide good recovery of grip strength and pain relief.
Surgery is reserved for patients whose pain has lasted 3-6 months without significant relief from conservative treatments. Surgical options range from open, arthroscopic and percutaneous procedures. The goal of surgery is to remove the damaged tissues and reattach healthy tissue to the bone. Up to 90% of surgery patients will find pain relief and be able to perform all activities without restriction. Recovery after surgery can take 4-6 months
When you or a loved one is suffering with tennis elbow contact Ortho Illinois. At Orthro Illinois our board-certified, fellowship trained orthopedic upper extremity surgeons are experts in the diagnosis and treatment of orthopedic conditions. Patients in northern Illinois and the Chicago region have easy access to our esteemed surgeons at multiple locations for your convenience. Contact us to schedule a consultation and receive the correct diagnosis and care.