DESCRIPTION AND SYMPTOMS
What is lateral epicondylitis?
Lateral Epicondylitis, Humeral Epicondylitis, and Epitrochlear Bursitis, all more commonly known as tennis elbow, refer to an elbow injury that is caused by an overuse of the forearm muscles that affects the extensor carpi radialis brevis or 2nd radial (100% of cases) and, to a lesser extent, the common extensor of the fingers (35% of cases). It consists of a degeneration of the tendons responsible for connecting the forearm muscles with the outside of the elbow. Therefore, although generally referred to otherwise, its correct name is tendinosis (-nosis = degeneration) and not tendinitis (-itis = inflammation).
In Lateral Epincondylitis, the muscles and tendons of the forearm are damaged by overuse and repetition. Age, smoking and diabetes are factors that can influence, exasperate, or worsen a patient’s condition or prognosis.
Other injuries related to the wrist:
1
2
What are the symptoms of tennis elbow?
Often the most affected arm is the dominant one, but both arms can be affected.
Diagnosis of Tennis Elbow is clinical. Calcifications may appear on radiography or, on an ultrasound, the injury can be diagnosed from seeing a loss of tendon echogenicity (ability to bounce sound waves during examination), intra-substance ruptures (hidden tears in the tendon), calcification deposits, and/or increased vascular uptake (increased Doppler signal power).
Although formal diagnosis requires a clinical exam, common symptoms of the injury include:
Pain or burning on the outside of the elbow. In most cases it starts out mild and gradually worsens as the weeks and months progress. There is usually no specific moment of injury associated with when symptoms start.- Weak grip strength.
- Pain when performing wrist extension with the elbow straight and counter-resistance applied (Cozen’s sign).
- A worsening of symptoms is common with forearm activity, such as holding a racket, turning a key, or shaking hands.
Pain or burning on the outside of the elbow. In most cases it starts out mild and gradually worsens as the weeks and months progress. There is usually no specific moment of injury associated with when symptoms start.If the injury is not treated in time
If left untreated, Tennis elbow, like any other type of injury, can lead to future problems for the health and wellbeing of the patient:
Work
If not treated by specialist who can adequately determine and execute appropriate treatment, the patient will not be able to perform their job with total normality.
Sport
Most people don’t stop their sporting activity, but if the circumstances causing the injury aren’t stopped or corrected in time, internal damage to the elbow will only worsen.
Immobilization
Failure to treat the injury also results in partial immobilization of the area, and in the worst cases, a complete inability to move the elbow joint.
How is humeral epicondylitis (tennis elbow) prevented?
By doing stretching exercises before and after each sporting activity or working day with the objective of preventing injury to the elbow tendon and strengthening the extensors of the forearm.
By correcting your sporting or professional movements.
To do this properly, it’s best to consult with your coach to avoid poorly performed movements and eliminate excessive tension that can otherwise overload the tendons and cause them to become damaged.
TREATMENT
How is humeral epicondylitis (tennis elbow) treated?
How is humeral epicondylitis (tennis elbow) treated?
- The first measure to take is to modify the activity that caused the injury. Improper sports technique or harmful repetitive movements should be reviewed. This “movement re-training” is key to recovery.
- For the treatment of tennis elbow, cryotherapy or application of ice packs, should be used as soon as symptoms appear, along with rest and the use of non-steroidal anti-inflammatory drugs (NSAIDs).
Read more
- The ideal complement to recover from this injury is physiotherapy. Eccentric exercises (simultaneous contracting and lengthening of the muscles) combined with isometric contractions (stretching the muscles by using them without allowing them to lengthen or shorten) are the most effective. Massage therapy in trigger points, the use of ultrasound or electrotherapy can also help reduce pain in the short term.
Source: Seo JB, Yoon SH, Lee JY, Kim JK, Yoo JS. What Is the Most Effective Eccentric Stretching Position in Lateral Elbow Tendinopathy?. Clin Orthop Surg. 2018;10(1):47-54.
- In cases where this initial treatment has been unsuccessful, shock waves or injections of either Glucocorticoids or PRP (Platelet-rich plasma) may be suggested. The use of glucocorticoid steroid injections is mildly controversial, however, as while in the short term they eliminate pain but in the long term there is no evidence that their use proves beneficial for treating the injury.
- Extreme and chronic cases of epicondylitis require a surgical option. There are several surgical techniques, the most classic being performed by open surgery while the minimally invasive techniques are performed by arthroscopy or ultrasound guidance. In both approaches, the objective is the release of the tendon from the bone.
How is arthroscopic surgery for tennis elbow performed?
- Surgical intervention is performed under localized anesthesia together with general anesthesia on an outpatient basis.
- Only two 5mm incisions are required, one to insert the camera and see the injury and another to introduce the instruments needed to repair the tendon.
Read more
- Treatment consists of detaching the connective tissue between the tendon and the bone. The surgeon will make sure to completely release this damaged tendon without affecting the ligament that is next to it.
- Once surgery is complete, the 2 incisions are closed with dissolvable stitches.
The duration time for the entire surgical procedure varies but does not usually last longer than an hour and a half.
FREQUENTLY ASKED QUESTIONS
What is recovery like after surgery for Tennis Elbow?
After a surgical intervention for tennis elbow, the patient should follow the following guidelines:
- Apply ice packs to the dressing or bandage over the incision or wound 2 to 3 times a day, 20 to 30 minutes at a time, without wetting the wound. Ice helps reduce inflammation, but it is very important that it is wrapped in a cloth or towel and not placed directly on the dressing.
- Take the prescribed painkillers as directed to help mitigate the pain, especially the first days after surgery.
- Begin moving the arm gently following your doctor’s instructions, even though the surgeon will likely leave a thick bandage or splint on the wound.
- Keep the dressing and wound clean and dry; follow the surgeon’s instructions on when the dressing should be changed.
After the first week, the bandage, splint and stitches will be removed, thus allowing rehabilitation to begin.
What are possible complications from arthroscopic elbow surgery?
Possible complications following arthroscopic surgery for humeral epicondyliti (tennis elbow) include:
- Pain, although gradually relieving, may persist for a period of 4-6 weeks.
- Stiff elbow, if you don’t perform the critical stretching exercises and movements as your surgeon instructs you to do, beginning immediately after surgery.
- Injury to the elbow’s lateral ligament.
How long does arthroscopic surgery to treat Tennis Elbow take?
Duration time to perform arthroscopic surgery for tennis elbow varies depending on factors such as the surgeon’s experience, the type of injury being treated, and the characteristics of the patient, but don’t usually last longer than an hour and a half.
REFERENCES
Morrey B, Sanchez Sotelo J, Morrey M. Morrey’s The Elbow and Its Disorders, 5th Edition. 2018. ISBN: 978-0-323-34169-
Lai WC, Erickson BJ, Mlynarek RA, Wang D. Chronic lateral epicondylitis: challenges and solutions. Open Access J Sports Med. 2018;9:243-251. Published 2018 Oct 30. doi:10.2147/OAJSM.S160974
Barratt PA1, Selfe J A service evaluation and improvement project: a three year systematic audit cycle of the physiotherapy treatment for Lateral Epicondylalgia.Physiotherapy.2018 Jun;104(2):209-216. doi: 10.1016/j.physio.2017.09.001. Epub 2017 Sep 22.
MS Cohen, AA Romeo, SP Hennigan, et al.: Lateral epicondylitis: anatomic relationships of the extensor tendon origins and implications for arthroscopic treatment. J Shoulder Elbow Surg. 17:954 2008 18619863
If you would like more information about treating Tennis Elbow, or would like to speak with Dr. Villanova directly regarding arthroscopic surgery to treat it, click here:
This post is also available in: Spanish
