Lateral Epicondylitis, or tennis elbow, is a common cause of elbow pain and is considered a cumulative trauma injury. This means that the injury occurs over time from repeated use of the arm and forearm. The pain is caused by small tears and damage to the tendons that attach muscles to different parts of the arm. Repeated motions can lead to pain and tenderness on the outside of the elbow because of these injuries.
There are many different kinds of treatments for tennis elbow and in most cases primary doctors, physical therapists, and surgeons will work together to find the most effective treatment for the patient. If surgery is recommended, patients have two main options, open surgery and arthroscopic surgery. Open surgery is the most common procedure, which involves doctors making an incision over the elbow. Surgeons move the soft tissue out of the way and remove any damage and secure any loose tendons to the surrounding tissue. With elbow arthroscopic surgery the damage is repaired by doctors using tiny instruments through small incisions. The damaged tissue is removed and any loose tendons are secured to the surrounding bone. Once the damage has been repaired, doctors will stitch the incisions closed and bandage the area. Even though arthroscopy is a minimally invasive surgery, it is important to understand all of the risks and to follow the doctor’s instructions.
Tennis Elbow Causes
Most people who are affected by tennis elbow are between the ages of 30 and 50, but there are other reasons why tennis elbow can develop:
- Overuse – Damage that is done to the extensor carpi radialis brevis (ECRB) muscle is thought to be the reason why tennis elbow develops. The ECRB muscle helps stabilize the wrist when the arm is straight and can become weakened from overuse. Microscopic tears can form in the tendon and lead to inflammation and pain. The ECRB is also at increased risk of damage because as the elbow bends and straightens the muscle rubs against the bumps on the bone. This constant rubbing can gradually wear at the muscle and cause tears to develop over time.
- Activities – Any job or activity that requires repetitive and vigorous use of the forearm can cause tennis elbow. Certain activities which can cause or aggravate tennis elbow include using plumbing tools, driving screws, cooking, or driving screws.
- Unknown – Sometimes tennis elbow can occur for reasons doctors don’t understand yet. When this happens it’s called insidious.
Tennis Elbow Symptoms
The main symptom of tennis elbow is pain that is located in the elbow area, sometimes it can be painful to lift or grasp objects. You may feel pain while doing simple action, such as shaking hands, turning a doorknob or holding a cup of coffee. Other symptoms include:
- Swelling or tenderness at the outside of the elbow.
- Aggravated symptoms when extending the wrist.
- Tenderness at adjacent muscles.
While making a diagnosis, your orthopedist will ask how your symptoms developed, and whether you have any specific occupational risk factors or if you participate in recreational sports. Along with a physical examination, your doctor will ask if you have injured your elbow and if you have a history of rheumatoid arthritis or nerve disease. Your doctor may ask you to straighten your wrist and fingers to see if your muscles are healthy when resistance is applied. Additional tests may help rule out other conditions. These tests include:
- X-rays: to rule out elbow arthritis.
- Magnetic Resonance Imaging (MRI): your doctor can check if you have a possible herniated disk or arthritis of the neck, which can produce arm pain.
- Electromyography (EMG): this test can detect nerve compression which produces symptoms similar to tennis elbow.
Tennis Elbow Treatment
Nonsurgical treatment proves to be successful for up to 95% of patients, and initial treatment seeks to reduce pain and inflammation. Therapies may include:
- Rest from aggravating activities.
- Using proper equipment for racket sports to reduce stress on the forearm.
- Physical therapy to improve muscle healing, which may include ultrasound, deep friction massage, ice massage, stretching, or muscle-stimulating techniques.
- Brace or splint to cover the back of the forearm to reduce symptoms by resting the muscles or tendons.
- Cortisone injections to improve damaged muscle to relieve symptoms.
- Extracorporeal shock wave therapy to create “microtrauma” which promotes the body’s natural healing processes.
If you have incapacitating pain that lasts for more than six months and doesn’t respond to conservative care, you may be a candidate for outpatient surgery to repair the diseased, degenerated tendon tissue. Operative care is rarely necessary, but it can be indicated when pain is so severe that it inhibits daily life.
Like with any surgery, there are risks involved that patients need to be aware of:
- Nerve and blood vessel damage
- Possible prolonged rehabilitation
- Loss of strength
- Loss of flexibility
- The need for further surgery
Tennis elbow causing constant amounts of pain? It's time you finally get treated. West Medical has perfected minimally invasive procedures that will aid your condition with long-lasting relief. If you are interested in learning more about treatment for tennis elbow, as well as other sports medicine services in Los Angeles, please call our West Medical offices at (855) 690-0565 and one of our representatives will be happy to address any of your questions, comments, or concerns.
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