Tennis Elbow Treatment

OVERVIEW

Lateral epicondylitis, or more commonly known as tennis elbow, is a condition that affects the lateral (outside) aspect of the elbow. The extensor muscles of the forearm attach on the lateral epicondyle of the humerus. With repetitive movements such as gripping, the extensor tendons pull on the epicondyle. Repeated muscular contraction causes small tears in the tendon followed by an ineffective healing process that leads to a chronic degeneration. Tennis elbow is frequently observed in the patient’s dominant arm and the most common tendon injured is the extensor carpi radialis brevis.

  • Up to 50% of all tennis players (risk factors include: poor technique, and incorrect racket or grip)
  • Laborers who use heavy tools
  • Anyone engaging in repetitive gripping or lifting tasks
  • Most commonly seen in patients between the ages of 35 and 50
  • Pain develops on the outside part of the elbow.
  • The pain is worse with gripping activity where the wrist and elbow are extended.
  • Discomfort or pain with holding objects such as a gallon of milk.

Dr. Alkhatib and his team meets with each patient to discuss their symptoms and any relevant history. Dr. Ahmad then performs a physical examination, including range of motion and special tests, to further confirm the diagnosis. In some situations, an MRI scan may be ordered to determine the severity of the epicondylitis.

  • Diagnosis is confirmed after evaluation
  • Physical exam is comprised of the lateral elbow and related structures
  • X-ray imaging is used to determine the status of the bony anatomy
  • MRI aids in determining the severity of the lateral epicondylitis.
    • MRI detects tendon tears or signal changes related to tendinopathy

Dr. Loiy Alkhatib

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EVALUATION BY TEAM  DR. ALKHATIB

Dr. Alkhatib and his team of health professionals will greet you and start your visit with a discussion of your symptoms.
Next, the doctor will exam your shoulder, focusing on:

  • How your shoulder was injured
  • Pain points and reported levels of pain
  • The range of motion of each shoulder
  • If necessary, Dr Alkhatib may request an imaging scan, like an X-Ray or MRI,
  • so he may better determine the extent of your injury.
  • In extreme cases, a CT scan may be required.

TREATMENT OPTIONS

Treatment of lateral epicondylitis is dependent on a number of factors including duration and severity of symptoms. Patients may elect for non-operative or surgical treatment based on evaluation and shared decision making with Dr. Alkhatib and his team.

NON-SURGICAL
  • First treatment step, which is successful for many
  • Eliminate the activities producing pain
    • i.e., lifting weights, intense gripping
  • NSAIDS and a rehabilitation protocol
    • Decrease inflammation, icing, compression wrap
    • Physical therapy should focus on eccentric strengthening
  • Some patients elect to use a tennis elbow brace during the day or with activities

Injection Treatments

  • May be used if oral NSAIDs do not help
  • 2 different types: Cortisone and Platelet-Rich Plasma (PRP)
  • Cortisone helps to alleviate any inflammation right at the source
  • PRP is used in the treatment of more severe lateral epicondylitis
OPERATIVE TREATMENT
  • Option for patients that do not see relief from non-surgical treatments
  • 3 different surgical options

Percutaneous debridement

  • Most minimally invasive surgery (see video).
  • Performed with a single incision the size of the tip of a pen
  • Ultrasound guidance.

Arthroscopic debridement

  • Minimally invasive with use of a camera
  • Allows Dr. Alkhatib to evaluate for additional intra-articular injuries

Open Debridement

  • Small incision
  • Recommended in more advanced cases of lateral epicondylitis
  • Allows Dr. Alkhatib to visualize the damaged tissue
  • Damaged tissues is excised and healthy tissue is repaired
RECOVERY
  • Sling for 24 hours
  • Wrist splint for 4 to 6 weeks (varies on severity of epicondylitis)
  • Physical therapy helps decrease swelling, pain, and to regain strength in extensor muscles
  • Avoid gripping activities such as opening a jar or lifting objects greater than 3 pounds.