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Tennis Elbow

What is Tennis Elbow or Lateral Epicondylitis ?

Tennis elbow is a painful condition in which the tendons and muscles that left or extend the wrist become inflamed or degenerated as they insert onto the elbow (the lateral epicondyle). The tendons are the rope like structures that move different fingers of your hand and wrist, and these tendons originate in muscles. In this condition, the muscles that lift or extend the wrist become irritated and degenerated in the area they insert onto the elbow (or lateral epicondyle).

What causes Tennis Elbow?

In most cases, the true cause of Tennis Elbow is unknown. Generally speaking, most believe repetitive wrist extension or lifting the wrist causes the insertion of the muscles to become inflamed or degenerated, which causes pain. With further repetitive motion, the condition tends to get worse and more painful.

What are the symptoms of Tennis Elbow?

Patients with Tennis Elbow often describe significant pain and swelling at the top side of the elbow in the area of the elbow bone known as the lateral epicondyle. The pain is aggravated by lifting the wrist or any activity that involves extending the wrist and arm.

How is Tennis Elbow diagnosed?

The diagnosis of tennis elbow is generally made on physical examination. Our hand surgery specialist will perform numerous physical exam maneuvers, and combined with the story of your injury, will determine if tennis elbow or lateral epicondylitis is suspected. Additional tests, such as an ultrasound or MRI may be ordered, to help diagnose the injury.

What treatments are available for Tennis Elbow?

The goal in treating tennis elbow is to eliminate the pain, thereby allowing full, painless movement of the wrist and arm. At The Center for Hand & Upper Extremity Surgery, we use an algorithmic approach to treat this common problem, which has been historically notoriously difficult to treat.

First, we will start with non-operative treatment measures such as splinting and changing the pattern in which you use your hand. We will likely send you for evaluation by a specialized hand therapist to begin a rigorous hand therapy protocol. We may offer you a steroid injection or PRP (platelet rich plasma) injection, depending on your situation.

If the pain continues, surgical treatment will be considered.  Tennis elbow is notoriously difficult to treat and therefore, surgical treatment must be considered with a meticulous approach. Traditionally, surgery involves an invasive procedure with an incision at the elbow to identify the area of the degenerated muscle attachments, cleanse them of all debris, and reattach them to the bone. This procedure, although reliable in pain relief, requires a significant period of down time, immobilization, and hand therapy to obtain reliable relief.

Are there any other surgical options that are minimally invasive?

Historically, tennis elbow has been treated surgically with an invasive procedure that requires a “big surgery,” a significant period of down time including both immobilization of the elbow as well as months of physical therapy. Many patients desired a less invasive option that could allow reliable improvement of their pain without the significant post-operative recovery time.

Denervation is a procedure that addresses the “supply” of pain to the brain rather than the area of degeneration itself. Through small minimally invasive incisions, your surgeon can meticulously and microscopically dissect the nerve branches to the lateral epicondyle and remove them systematically. By removing the nerve branches to the region, your surgeon has eliminated the signals of pain to your brain without disturbing the muscle or joint biomechanics themselves. Therefore, there is no need for a prolonged recovery – there is no casting, there is no therapy, and there is no restriction on motion post operatively. Many patients prefer this operation due to the reliable pain relief with limited down time as the first “rung” on their treatment ladder. Our hand surgery specialist will let you know upon review of your situation whether or not you are a candidate for this newer minimally invasive method of treatment.

Will I need therapy for Tennis Elbow?

Hand therapy is generally a standard component in the treatment of tennis elbow.

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