Tennis Elbow – Lateral Epicondylitis

Tennis Elbow or Lateral Epicondylitis is a painful condition of the lateral elbow that typically occurs because of overuse.  The muscles that attach to the lateral epicondyle of the elbow, primarily responsible for wrist extension,  get injured.  The condition is very common in tennis players, but racquetball, squash and pickle ball players are not immune to the common condition.   The condition can develop in almost any age, but it is most common in people 40 years and older.  Lateral epicondylitis can also occur in people who do a lot of repetitive motions like carpenters, typists, painters and knitting hobbyists.

Causes of Tennis Elbow

Tennis elbow can occur because of repetitive motions involving the wrist, but can also occur because of gripping a racket too tight, improper backhand swing technique, and using a racket that is strung too tight.  Repetitive motions can strain wrist extension muscles.  The repetitive motion can put too much stress on the tendons and lead to inflammation.  The constant strain can result in microscopic tears in the junction between the muscle and bone.

Symptoms of Tennis Elbow

Common symptoms of Tennis Elbow include pain when gripping a tennis racket, pain when trying to extend your wrist, tenderness along the lateral edge of the elbow. Pain may radiate up and down the arm.

Treatment for Tennis Elbow and Lateral Epicondylitis

  • REST
  • ICING
  • TENNIS ELBOW BRACING
  • NSAIDS
  • ROM EXERCISES
  • SHOCKWAVE THERAPY
  • RED LIGHT LASER THERAPY
  • PROLOTHERAPY
  • PRP – PLATELET RICH PLASMA
  • STEROID INJECTIONS
  • DRY NEEDLING

REST-ICE

Although some athletes do not like to hear that they may need to take a break from their sport to allow for healing, it is important to give the muscles a chance to rest and heal.  Further,  icing can help to reduce inflammation and swelling. 

BRACING

A tennis elbow strap will change the fulcrum of the wrist extension muscles from the boney insertion to the area under the strap, effectively shortening the lever arm involved in wrist extension.  NSAIDS, nonsteroidal anti-inflammatory drugs, like ibuprofen and aleve can be used to reduce inflammation and swelling.

EXERCISES AND STRETCHING

Range of motion (ROM) exercises can help to prevent stiffness and improve blood flow to the area and promote healing.

SHOCKWAVE THERAPY

Shockwave therapy can be utilized to stimulate blood flow to the area and break up any adhesions.  Shockwave therapy has been shown to lessen symptoms and shorten recovery times. 

STEROID INJECTIONS

Steroid injections have been shown to reduce inflammation, decrease pain, and expedite healing. 

DRY NEEDLE INJECTIONS

Dry Needle injections use a sterile needle inserted into the area of pain to simulate tissue injury and trigger the healing cascade. 

PLATELET RICH PLASMA

PRP, platelet rich plasma, injections have shown excellent results in healing recalcitrant cases of tennis elbow and reduced the need for surgery in many patients (1).  PRP uses the patient’s own blood to isolate platelets which are reinjected into areas in need of healing. 

PROLOTHERAPY

Prolotherapy uses injections of a dextrose solution as an irritant which triggers the body’s healing response.  Once triggered, the body will strengthen and repair damaged ligaments and tendons.   

RED LIGHT THERAPY

Red Light laser therapy uses intense light energy at a certain frequency that stimulates mitochondria within cells.  Mitochondria are responsible for energy production within the cell which. By stimulating mitochondria to produce more energy, cellular healing and regeneration can take place faster. Additionally, the heat generated by the laser stimulates blood flow to the area and helps to clear inflammatory mediators and speed up the healing process.

Research / Citations:

(1)  Graham Hastie, Mazen Soufi, James Wilson, Bibhas Roy, Platelet rich plasma injections for lateral epicondylitis of the elbow reduce the need for surgical intervention, Journal of Orthopaedics, Volume 15, Issue 1, 2018, Pages 239-241