As a hand and upper extremity Orthopaedic surgeon, I see many patients that present to my office with pain in their elbow and forearm. For a certain subsets of these patients, I ultimately diagnose them with lateral epicondylitis, or tennis elbow. Oftentimes, their reaction is the same. They say, “Doc, I don’t even play tennis, how could I have tennis elbow?!” Unfortunately, many people assume that lateral epicondylitis will only affect those individuals that are active in racquet sports, when in reality; tennis elbow can affect both men and women regardless of their hobbies.
Lateral epicondylitis became forever known as tennis elbow back in the late 1800’s when it was described as “lawn tennis arm” by a British surgeon, Henry Morris, in 5 men that were active in his lawn tennis club. Since that article in 1883, tennis and lateral epicondylitis have become inextricably linked. What Dr. Morris was describing, was the degeneration of the fibrous origin of the extensor tendons as it inserts on the lateral epicondyle. This degeneration is thought to be secondary to repeated mechanical overload leading to microtears and mucinoid degeneration. Ultimately, patients will present with significant pain on the lateral aspect of their elbow, especially with activities that involve wrist and elbow extension and forearm pronation (think of a backhand volley in tennis).
The frustrating thing about tennis elbow is that this pain can last for a very long time. Patients often come in with six or even twelve months of symptoms of lateral epicondylitis. I tell my patients that while it can take a long time; the good news is that it will almost always get better with conservative treatments. Orthopaedic surgeons have tried a number of treatments in an attempt to make lateral epicondylitis resolve more quickly than its natural history of six to twelve months. In fact, one of the first randomized controlled trials in Orthopaedics looked at steroid injections vs placebo for tennis elbow. While there are many purported treatments out there, what we know is that the most consistent conservative treatments involve occupational or hand therapy and forearm strapping, which off-loads the muscle origin at the elbow. If people continue to have persistent pain despite strap and brace wear and therapy, the next line of intervention usually involves an injection of steroid or platelet-enriched plasma. Only if someone hasn’t improved despite all the other proven conservative treatments, will I consider surgery for tennis elbow. Surgery can be effective, but I tell my patients that it usually is not a “quick fix” and can take 4-6 weeks to recover after surgery.
I know my perspective is a little skewed, but sometimes it seems as though most people will experience tennis elbow at some point during their lives. While this condition can be quite debilitating, the good news is that for most people, time and concerted conservative treatment will eventually cause their symptoms to lessen and ultimately resolve.
Michael D. Smith, MD
Hand and Upper Extremity Surgeon
Southlake Orthopaedics Sports Medicine & Spine Center, PC
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