Lateral Epicondylitis (Tennis Elbow)
Anatomy: The ECRB (extensor carpi radialis brevis) originates from the lateral epicondyle at the outside of the elbow. It is delicate and is the inflamed structure in "tennis elbow"
Injury: When gripping tightly this tendon fires continuously to hold your wrist cocked with your hand upward. This position stretches the gripping flexor tendons and makes them, hence your grip stronger. It is a hard-wired subconscious maneuver that your body does subconsciously. However, if a prolonged power grip is used the tendon becomes strained and inflamed. Another mechanism of injury is repetitive lifting with the palm down which also strains this tendon
Diagnosis: Tenderness at the lateral epicondyle is always present. In addition, the “middle finger” test in which hand and arm are held out and downward pressure against resistance is placed on the middle finger causes pain because the ECRB attached at the metacarpal bone below the base of the middle finger.
Treatment:
- Relative Rest: Avoiding prolonged power grip, i.e. gripping only as hard as you need to, will allow gradual healing. Lifting should also be done with the palm upward. Studies have shown that it often takes about 18 months for resolution of symptoms.
- PRP Injection: We specialize in this treatment. If relative rest fails PRP injection usually but not always greatly decreases symptoms while promoting tendon healing. It is still necessary to modify activities after this to facilitate healing and prevent recurrence.
- Cortisone Injection: Short-term benefit occurs, but the problem tends to recur and cortisone is known to cause tendon cell death. Repeated injections can result in infection.
- Elbow Straps: These produce benefit initially, but must be accompanied by relative rest for long-term benefit to occur.
- NSAIDs (nonsteroidal anti-inflammatory drugs): These include Motrin, Advil, Aleve, Diclofenac, Meloxicam, and many others. They interfere with tendon healing, mask symptoms, allow worsening of the problem, and are highly toxic with chronic use for GI bleeding (often fatal), kidney failure, heart, and other problems. We strongly discourage their use.
- Physical Therapy: Eccentric stretching and strengthening have been recommended. In our experience, this is generally not effective and often aggravates the problem
- Surgery: We have also been disappointed with the results of surgical debridement, which primarily consists of attempting to remove damaged tendon tissue.
