How is your tennis backhand these days? Any pain around the elbow? Maybe you don’t play tennis but have been having this nagging pain when shaking hands or lifting a carton of milk out of the fridge! If that is the case it could be a case of Tennis elbow or Lateral epicondylitis. This is a common condition which produces pain on the outside of the elbow, in the region what we call the lateral epicondyle.

It occurs secondary to degeneration of the tendons that attach to the lateral epicondyle of the elbow.  These tendons are responsible for anchoring the muscles which extend the wrist and digits.

Lateral epicondylitis is typically seen in patients between 30 and 50 years of age, but can develop in any age group.  Although it is called tennis elbow, the majority of patients who develop this condition do not play racket sports.  In most instances, there is no recognizable injury.  It may occur secondary to tennis or other racket sports, other sports and activities that require repetitive use of the wrist and forearm extensor muscles (those involving lifting, gripping, and/or grasping), and oftentimes, there is no identifiable cause.

There are many treatments that have been described for lateral epicondylitis.  Initial treatment is centered on activity modification, bracing, an exercise program or physical therpy, and anti-inflammatory agents (if appropriate for the individual patient). Although cortisone injections have been advocated in the past, most of the recent literature has demonstrated that cortisone injections usually only provide short-term relief, and do not improve the long-term prognosis of lateral epicondylitis. In certain patients with acute, severe pain, steroid injections may be helpful.

Newer treatments that have shown promising results include shockwave therapy, and more recently, Platelet Rich Plasma Therapy. The latter is a technique which involves injecting concentrated portions of a patient’s own blood directly into the degenerative tendon of the lateral epicondyle, thereby stimulating the body’s own healing mechanism. Early results of this method have been quite encouraging.

The overwhelming majority of patients with lateral epicondylitis do improve without surgery. However, it can sometimes be a chronic condition, which may take upwards of 6-12 months to resolve. In a minority of patients, who do not improve with nonoperative treatments, surgery is indicated. This involves removing the degenerative tendon, and can be performed either through an open incision, or more recently, arthroscopically. Both of these techniques have been shown to be equally effective.

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