One of the injuries the avid tennis player is likely to suffer at some point in his or her career is tennis elbow. It is actually not uncommon in athletes of other sports, such as golf. In fact, many non-athletic individuals have this complaint.
Tennis elbow, or lateral epicondylitis, often starts with no specific injury. Tennis players might recall an increase in the frequency of practice or competition, as it is often an overuse injury. At first, certain strokes or positions, such as contact or follow through on backhand strokes, might be the only ones to illicit pain. As the problem continues, a variety of strokes or motions start to cause pain. Even normal daily activities, such as turning a doorknob or lifting heavy objects, can become uncomfortable. It is usually at this point that people usually seek orthopaedic advice.
In the office, an orthopaedic surgeon will determine that the pain is localized to a small area on the lateral side, or outside, of the elbow. The disease process involves one of the tendons that come off the bony prominence on the outside of the elbow. These tendons are those involved in extending the wrist, so pain extending or turning the wrist against even light resistance can be painful. X-rays are often used to rule out other problems, but in tennis elbow, they are usually unremarkable. Further tests, such as MRI’s, are not usually needed.
Fortunately for the vast majority of patients, including both athletes and sedentary individuals, tennis elbow frequently resolves without surgery. There are many options for treatment, and they are often used in combination. A tennis elbow strap or brace worn just below the elbow is intended to take pressure off the painful area, and it is worn while doing manual activities. Anti-inflammatory medications and ice, especially after activity, can be helpful. Working with a physical or occupational therapist for stretching and strengthening exercises, and even modalities such as ultrasound, is often recommended. Cortisone injections are often offered, although there is some conflicting data about the effectiveness of these shots in treating the underlying problem. Newer treatments, such as platelet-rich plasma injections, prolotherapy, and shockwave therapy have been suggested, and research is needed to determine their effectiveness. It is thought that the wrong grip size or string tension on the racquet might be an underlying cause of tennis elbow, so seeking the advice of a knowledgeable tennis pro might help prevent the problem from returning.
In the rare patient with continued pain despite long efforts to try to treat the injury with some of these conservative measures, surgery is an option. Most of the time a small incision to find the diseased area of tendon, cut it out, and repair the tendon to bone is the treatment of choice. It is a quick surgery done as an outpatient, but it does require months to return to full activities. For that reason, surgical treatment is often seen as a last resort. New techniques create hope for severe injuries.Elbow Injuries
Distal Biceps Tendon Rupture
Lateral Epicondylitis (“Tennis Elbow”)
Little Leaguer’s Elbow
Medial Epicondylitis (“golfer’s elbow”)
Olecranon Stress Fracture
Osteochondritis Dissecans of the Capitellum
Triceps Tendon Rupture
Ulnar Collateral Ligament Injuries (“Tommy John Surgery”)
Ulnar Neuritis (Ulnar Nerve Compression)
Valgus Extension Overload