Lateral Epicondylosis (Tennis elbow)

What is it?
Lateral epicondylosis (also known as tennis elbow) is a painful condition that affects the lateral side (the outside) of the elbow, where the extensor tendons attach. Over time, the tendons can undergo a type of degeneration, with changes in the microscopic structure that can alter the way they work. It used to be thought that the tendons get inflamed, but this has been found to be not the case, as there are few inflammatory cells present in the affected tendons. The symptoms most people experience typically include pain right at the point where the tendons insert into the end of the humerus. Pain may be worse with wrist or finger extension. Activities that stress the extensor muscles such as tennis or using a screwdriver are commonly associated with the development of pain in this area.

What causes it?
It is believed that repetitive trauma (overuse) causes microscopic tears in the tendon structure and over time this leads to development of abnormal tissue. The abnormal tissue causes pain, although the reason why this is so is not known.

What is the conservative (first line) treatment?
Lateral epicondylosis is for the most part a self-limited condition. The pain can last for a long time however, with some patients taking up to 2 years to heal completely. Avoiding exacerbating activities is generally successful in treating this condition. While absolute rest is not necessary, simply avoiding doing things that hurt the area is usually sufficient to resolve the symptoms. Some patients respond well to stretching exercises. Gentle massage may help as well. A forearm strap worn just past the point of tenderness may help relieve symptoms, especially doing sports. The strap may work by slightly altering the angle of insertion into the bone, although it is not really known why it works.

What if that fails to relieve my condition?
If conservative measures fail, the next step may be to have a steroid injection into the area. The steroid may help relieve the pain, and it may help reduce the degeneration of the tendon. If that fails, surgery may be an option. Surgery involves a one inch incision over the area, and the abnormal tendon is excised. You may be in a splint for a few weeks, followed by a few weeks of physical therapy if your surgeon determines that to be necessary.

How successful is surgery for this condition?
Surgery is generally successful for this, but it is important to realize that surgery is only rarely needed. Over 95% of patients will not require surgery for this condition.

What can I do to prevent this from happening again?
Work on general exercise of your wrist extensor muscles. Try to avoid exacerbating activities, such as repetitive motions like using a screwdriver, etc. Lateral epicondylosis may come and go. Try to recognize the early symptoms and treat them aggressively. This may help prevent a full-blown flare-up.