TENNIS ELBOW by Dr. Gregory Sarkisian

Many patients complain of elbow pain. One of the most common reasons that patients visit their physician is for lateral epicondylitis, more commonly known as tennis elbow. Tennis elbow is an inflammatory condition of the tendons and bony prominence on the outside of the elbow. This condition is brought on by repetitive use of the arm. Most patients with this condition have never even played tennis. It is commonly aggravated by doing household chores. Everyday activities including; running the sweeper, using a chain saw, weed whacker or lawn mower can cause tennis elbow. Simply performing tasks that require holding an object with a tightly clenched fist can bring on the pain. Symptoms can also be aggravated by direct impact over the lateral aspect (the side of the elbow away from the body) of the elbow which can be quite painful during this condition. Tennis elbow can get quite severe and cause not only pain and weakness, but also elbow stiffness. When this condition is at its worst, it is quite difficult to even grasp simple objects due to the pain on the lateral aspect of the arm. Oftentimes it is difficult to fully extend or straighten the elbow. Simple tasks such as holding a coffee pot or gallon of milk become very difficult. A simple test for tennis elbow is to fully straighten the arm and clench your fist tightly. If this causes pain on the lateral aspect of the elbow, you very well may have lateral epicondylitis. Also, you will have quite a bit of tenderness over the bony prominence
on the outside of your arm.

The good news is that treatment for tennis elbow is usually conservative. Very seldom is surgery indicated for this problem. The bad news is that tennis elbow can come and go and can sometimes be quite difficult to eradicate completely. One of the cornerstones for treatment of lateral epicondylitis is the use of a tennis elbow brace. This brace consists of a strap which goes approximately two inches below the crease of the elbow. It has a pad or a cushion that is placed two finger widths below the bony prominence or painful area of the arm. This is to be worn throughout the day during activities of aggravation. The brace should be removed in the evening and during periods of rest. These braces can easily be obtained at the drug store or at a sporting goods store. Also anti-inflammatory medications such as over the counter Advil or Aleve can help decrease the inflammation due to this condition. Please be aware of the side effects of these medications. The use of cold compresses can also decrease the inflammatory process around the elbow. Ice should be applied for twenty minutes, three or four times a day. If you have tried these measures and after two weeks you continue to experience elbow pain, medical attention may be necessary. Oftentimes corticosteroid injections in the lateral aspect of the elbow can decrease the pain and inflammation of this condition almost instantaneously. Sometimes these injections may need to be repeated. In the vast majority of cases, these conservative measures are all the treatment that is required for lateral epicondylitis, or tennis elbow. Very few patients require further treatment.

In stubborn cases, there may be a need for further intervention. A new injection technique is now available to patients. It consists of drawing blood from the patient and removing special anti-inflammatory cells from
the blood and then re-injecting these cells into the lateral aspect of the elbow. The last resort for treatment
of tennis elbow is surgical intervention. A small incision is created over the lateral aspect of the elbow and
the inflamed tissue is surgically excised. In my experience, the need for surgical treatment for tennis elbow
is far less than one percent of the cases.

To summarize, you don’t have to play tennis to have tennis elbow. It is a very common condition that usually can be treated in a conservative fashion. If you try these conservative modalities and your pain persists, give your physician a call.

Dr. Gregory Sarkisian is a partner at Precision Orthopaedic Specialties, Inc. and he is Chief of Orthopaedic Surgery at University Hospitals Geauga Medical Center

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