Lateral Epicondylitis

What is lateral epicondylitis?

Lateral epicondylitis is commonly referred to as tennis elbow. This condition involves inflammation or tearing of the extensor carpi radialis brevis tendon (ECRB). The ECRB tendon originates over the lateral or outside of the elbow. The tendon inserts on the wrist at the second metacarpal and is involved in wrist extension. In tennis elbow, repetitive overuse activities or trauma can result in damage to the tendon origin. Activities such as tennis, weightlifting, skiing, or biking can result in tennis elbow. Typically, this condition occurs between the ages of 40-60 but can be seen in any age range. Lateral epicondylitis is described as a “tendinosis” which is slightly different than “tendonitis.” Tendinosis is considered more of a degenerative condition supporting the “overuse” component of the condition. This is partly why lateral epicondylitis is difficult to treat.

Diagnosing lateral epicondylitis

Symptoms include point tenderness over the lateral epicondyle, pain with wrist extension and elbow motion. Patients will often complain of difficulties with things like lifting a coffee cup or with sports activities. Pain can radiate up and down the arm and is commonly in the forearm. Other conditions such as radial tunnel syndrome and arthritis can have similar symptoms which is why it’s important that Dr. Kavi Sachar perform a history and examination.

Nonsurgical treatment of lateral epicondylitis

Nonsurgical treatment consists of rest, anti inflammatories, immobilization and therapy. The basic treatment of RICE is commonly employed. Rest, Ice, Compression and Elevation in early or minor lateral epicondylitis can be successful.   Anti inflammatories can be helpful but since it is more of a tenonitis than a tendonitis, they may be less successful. Patients must be cautious of the side affects of anti inflammatories and should discuss long term use with their primary care physician. Splinting is often helpful to protect and rest the tendon. Splints consist of either a counterforce elbow brace or wrist splint. The counterforce elbow brace is typically used during activities such as tennis. The wrist splint should be work full time for approximately 3 weeks to try to limit activity. Therapy involves strengthening the muscles through eccentric stretching. With therapy, patients are often able to regain normal function. Many studies have supported the importance of therapy and it is often considered the best long-term treatment because it allows for maintenance exercises to prevent recurrence. Occasionally, patients do not respond to these modalities. In that setting, corticosteroid injections may be used. Patients need to be cautious that the corticosteroids do not just mask the pain. Therefore, injections are often used in conjunction with the above modalities.

Platelet rich plasma (PRP) is a treatment that involves drawing a patient own blood and spinning it in a centrifuge to concentrate the platelet derived growth factor (PDGF) in the platelets. This PDGF may facilitate tissue healing. Research continues to be performed on this treatment modality.

Surgically treating lateral epicondylitis

Surgery for lateral epicondylitis involves removing the damaged tissue and repairing back the normal tissue. Less than 10% of patients with tennis elbow require surgery. Typically, conservative treatment is first exhausted, and the symptoms have been present for many months. Overall, the success of surgery is good. Surgery involves debridement of the tissue damaged by the tendinosis. This “footprint” of tissue is removed to decrease the inflammatory response. The remaining tissue is repaired back to restore strength to the elbow.

Recovering from lateral epicondylitis surgery

Patients are splinted immediately after surgery for several days. Therapy is started to work on range of motion and gradual strengthening. Patients can typically resume normal sports activities within 3 months and day to day activities right away.

Schedule a consultation

Board-certified and fellowship-trained hand surgeon Dr. Kavi Sachar is widely regarded as one the nation’s leading experts on lateral epicondylitis. Dr. Sachar has three office locations in Vail, Aspen, and Frisco, Colorado. If you or a family member suffer from lateral epicondylitis, contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.