Lateral Epicondylitis (Tennis Elbow)
Lateral epicondylitis, (or Tennis Elbow), is common condition affecting the lateral side of the elbow in many athletes. It is typically due to repetitive overuse. With regards to tennis players, a number of factors including poor mechanics (particularly during the backhand stroke) and innappropriate racket type can predispose them to developing lateral epicondylitis.
Patients with lateral epicondylitis complain of localized pain over the lateral epicondyle and wrist extensor muscle mass. Pain and weakness with resisted wrist extension and forearm supination are common physical exam findings. It is important to rule out other conditions that can cause similar symptoms such as radial head or capitellar cartilage lesions, and radial tunnel syndrome.
Conservative treatment is usually successful and involves activity modification, therapy and anti-inflammtory medications. If poor mechanics or equipment are implicated in the development of the epicondylitis, the issues should be addressed before returning to competition.
Acute Lateral Epicondylitis:
About 90% of the time, lateral epicondylitis will resolve with conservative treatment. The initial step towards recovery involves cessation of the offending activity. In this case, no tennis should be played. In addition to rest, regular icing and anti-inflammatory use can help. The gold-standard to improve the condition is a structured physical therapy program that focuses on stretching and strengthing the elbow and forearm muscles. Cortisone injections may help alleviate the pain of an actue flare-up but studies show that the benefit is temporary. When compared to athletes who undergo a formal physical therapy program, those that only get a cortisone shot do not fare as well. Cortisone injections, particularly if more than one is administered, may predispose the athlete to tendon rupture. For this reason, these injections are being used much less frequently than in the past.
When the athlete is pain free, it is safe to return to sport. The use of a counterforce, forearm brace can help dampen the stresses experienced at the elbow. It is critical to ease back into play.
Chronic Lateral Epicondylitis:
For those with persistent symptoms that fail to respond to the above-mentioned treatments, platelet-rich plasma and surgery become viable treatment options. Platelet rich plasma has shown promising results for treating tennis elbow. And, it isn’t associated with the same risks as cortisone injections. Up to two or three PRP injections are reasonable to try to eradicate the symptoms of lateral epicondyliits.
Patients who don’t respond to rest, therapy, antininflammatory medications or PRP injections are candidates for surgery. Surgery can be done arthroscopically or through an incision. The procedure takes about 20 minutes, however the recovery progresses slowly so as to prevent overuse of the tendon during the healing phase. Return to tennis typically starts at about 3-4 months.