|
Tennis Elbow
Tennis elbow, or lateral epicondylitis, is the most common injury in patients seeking medical attention with the complaint of elbow pain. Exactly what causes tennis elbow is unknown, but it is thought to be due to small tears of the tendons that attach the muscles of the forearm to the arm bone at the elbow joint.
The muscle group involved, the wrist extensors, function to cock the wrist back. Specifically, the extensor carpi radialis brevis, has been implicated in causing the symptoms of tennis elbow.
Treatment
There are several available treatments for tennis elbow. These usually start off conservatively, and work to more involved treatments. Non-operative treatment is successful in over 90% of patients.
*Lifestyle Modification. Lifestyle modification is important if tennis elbow does not resolve or if it recurs. With athletes, often an improvement in technique (see below) can resolve the problem.
*Changing Stroke Mechanics and Racquet. Tennis racquets should be sized properly, including grip size. Higher stringing tensions may contribute to tennis elbow. Playing on harder surfaces also increases the risk of developing tennis elbow. Stroke mechanics should be evaluated to ensure patients are hitting the ball in the center of the racquet and players should not lead the racquet with a flexed elbow. See a tennis pro/instructor for a swing and racquet evaluation.
*Anti-inflammatory Medications. Anti-inflammatory medications are often used to help control pain and inflammation. The oral forms of these medications are easy to take, and often help control the inflammation as well as manage the pain associated with tennis elbow.
*Cortisone Injections. If these conservative measures fail, a steroid (cortisone) injection is a reasonable option. If a person has tried more than 2 cortisone injections without relief, it is unlikely that additional injections will benefit the patient.
*Elbow Brace and Exercises. An elbow orthosis, called an elbow clasp, can be worn. The theory behind using this elbow clasp is that the brace will redirect the pull of malaligned muscles. Patients often find relief of pain when using the clasp during activities.
*Exercise. Some simple exercises can also be helpful in controlling the symptoms of tennis elbow. These exercises should not cause pain, and if they do the exercises should not be done until the pain resolves. By strengthening the muscles and tendons involved with tennis elbow, you can help prevent the problem from returning.
Surgery
Surgery to release the damaged tendon may be needed in a small percentage of patients. A significant trial of conservative treatment should be attempted prior to surgery. Surgery is usually successful, but rarely needed; about 95% of patients with tennis elbow can be treated without surgery.
There are several possible surgical treatments that have been successful. These include removing a portion of the damaged tendon or releasing the attachment of the affected tendon. A repair of the healthy portion of tendon is sometimes carried out as well.
How is surgery for tennis elbow performed?
There are many surgical procedures that have been described for the treatment of tennis elbow. The underlying similarity between these treatments is to remove the damaged tissue, and stimulate a healing response in the area of damaged tendon.
An incision is made over the outside of the joint. The area of damaged tendon is identified, and this portion of tendon is removed.
The underlying bone is exposed and blood flow to this region is stimulated. Some surgeons will repair the remaining tendon by using sutures anchored into the bone. The incision is then closed, and the patient placed in a splint. |
