What is Tennis Elbow? Understanding and Managing Lateral Epicondylitis

Diagnosis, Management, and Treatment Strategies

Lateral epicondylitis, commonly known as tennis elbow, is a painful condition that affects the tendons on the outer side of the elbow. While it’s often associated with tennis players, lateral epicondylitis can occur in anyone who performs repetitive gripping or wrist extension motions. As a board-certified hand surgeon, I encounter patients with lateral epicondylitis frequently, and it’s essential to understand the diagnosis, management, and treatment options available for this condition.

Diagnosis:

The diagnosis of lateral epicondylitis begins with a comprehensive medical history and physical examination. Patients typically report pain and tenderness on the outer side of the elbow, which may radiate down the forearm. Reproducing the pain with specific maneuvers, such as resisted wrist extension or gripping, can help confirm the diagnosis.

Imaging studies, such as X-rays or MRI scans, are usually not necessary for diagnosing lateral epicondylitis but may be ordered to rule out other potential causes of elbow pain, such as fractures or arthritis. They may also be used for insurance purposes to confirm the diagnosis in order to proceed with surgical treatment when nonoperative measures have failed.

Management:

Once diagnosed, the management of lateral epicondylitis focuses on relieving pain, reducing inflammation, and promoting healing of the affected tendons. Initial treatment may include:

1. Rest: Avoiding activities that exacerbate symptoms can help prevent further irritation of the tendons. Patients may need to modify their work or recreational activities temporarily to allow the elbow to heal.
2. Ice therapy: Applying ice to the affected area can help reduce pain and inflammation. Patients are advised to apply ice packs for 15-20 minutes several times a day, especially after activities that aggravate symptoms.
3. Pain medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help alleviate pain and reduce inflammation. In some cases, corticosteroid injections may be recommended to provide short-term relief of symptoms.
4. Occupational/Physical therapy: A structured physical therapy program can help strengthen the muscles around the elbow and improve flexibility. Therapeutic exercises, manual massage/stripping of the elbow tissue, stretching techniques also known as “eccentric stretching”, and modalities such as ultrasound or electrical stimulation may be included in the treatment plan.
5. Nighttime wrist splint: a wrist brace, often used to treat carpal tunnel syndrome, is often prescribed at the first visit. This is to be worn at nighttime only, not while you are awake. The rationale for this treatment is to rest the muscles and tendons which are inflamed and stretched, while sleeping. By avoiding flexion of the wrist, research and data has shown a decrease in nighttime and daytime pain.
6. Counterforce brace: a counterforce brace, worn 2 fingerbreadths distal to where the pain is, is recommended to be used for daytime activities. This brace or strap offloads the strain of the tendons as they pull on the bone, thereby allowing the tendinous tissue to heal and limit the pain during this period of treatment.

Treatment:

For patients with persistent or severe symptoms, despite conservative management, a surgical treatment options is available. Current evidence demonstrates that up to 85% of patients may be treated nonsurgically. However, sometimes the above treatments are not enough to improve symptoms. The most common surgical procedure for lateral epicondylitis is called a lateral epicondylar debridement, where the damaged tendon is surgically detached to relieve tension and promote healing. Both the tendon and the bone are cleaned, or debrided, to reset the painful healing to healthier tissue with a robust blood supply.

In conclusion, lateral epicondylitis is a painful condition that can significantly impact an individual’s quality of life. Prompt diagnosis and appropriate management are essential for achieving optimal outcomes and preventing long-term disability. By implementing a comprehensive treatment plan that includes conservative measures, such as nighttime splinting, daytime counterforce brace, rest, ice therapy, and occupational/physical therapy, as well as more advanced interventions like surgery, patients can effectively manage their symptoms and return to their normal activities with minimal disruption. As a board-certified hand surgeon, I am committed to providing personalized care and innovative treatment options to help patients overcome lateral epicondylitis and regain function and comfort in their daily lives.

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