Lateral Epicondylitis / Tennis Elbow

Lateral epicondylitis, more commonly referred to as tennis elbow, is an overuse injury affecting the forearm tendons near the elbow.  Tennis elbow is an extremely common condition, affecting up to 3% of adults each year.  

Anatomy and Causes

Lateral epicondylitis is an overuse injury of the extensor tendons of the wrist.  Specifically, the extensor carpi radialis brevis (ECRB) tendon is responsible for the majority of symptoms in tennis elbow.  This tendon travels from just above the elbow down to the wrist, and acts to extend the wrist.  The most proximal part of the tendon where it attaches to the humerus can become inflamed with repetitive activities.  This results in painful changes in the tendon, called tendinosis. Pain with tennis elbow is usually located near the bony prominence on the outside part of the elbow, termed the lateral epicondyle.

Symptoms and Associations

Patients with tennis elbow typically complain of an achy or burning pain located on the outside part of the elbow.  In most cases, patients do not recall a specific traumatic event before the onset of pain, but often have symptoms following a specific repetitive activity.  Patients often have pain with gripping activities and with sports such as golf and tennis.  

Lateral epicondylitis usually affects the dominant arm, and is more common in heavy laborers and those whose work requires repetitive gripping activities.  It most frequently affects people aged 35-50, though many patients outside of that age range experience it.  A small percentage of patients with tennis elbow may also have compression of one of the nearby nerves which may contribute to symptoms.

Treatment

The goal in treating lateral epicondylitis is to reduce pain and allow you to get back to full activities without symptoms.  

Non-operative

The initial treatment for tennis elbow is non-operative, and the vast majority of patients with lateral epicondylitis recover without the need for surgery.  Nonoperative treatment includes therapy and use of specific braces to reduce stress on the tendon.  Therapy for tennis elbow focuses on eccentric strengthening of the affected tendons.  Therapy can also include other modalities such as iontophoresis where topical medications are delivered to the affected area using an electrical field.  These modalities can help reduce pain and improve healing.  Wrist splints worn overnight allow the tendon to rest.  Forearm counter-force straps work to offload the affected tendon and can be helpful during repetitive or heavy activities.  In severe or ongoing cases, injections can be considered to hasten recovery.

Operative

Surgery for tennis elbow is reserved for patients who have ongoing symptoms despite appropriate non-operative treatment.  Only about 5% of patients with lateral epicondylitis ultimately need surgery.  Surgery involves removing the diseased portion of the tendon, which allows healing to take place.  Surgery is performed as an outpatient with no need for overnight stay in the hospital.