Lateral epicondylitis, commonly known as tennis elbow, is a common cause of elbow pain in adults. Rather than a specific incident causing the pain, it often follows a repetitive activity. Manual laborers often develop lateral epicondylitis.
Treatment options for tennis elbow
The first line of treatment is generally nonoperative. Among those remedies orthopedic surgeons and physicians use are counterforce straps, anti-inflammatory medications, activity modification and cortisone injections. Physical therapy often helps patients overcome this pain.
Usually orthopedic surgeons wait for 6 to 12 months before suggesting surgery for lateral epicondylitis. Fortunately a majority of patients improve and never need surgery. Trying to predict which patients will ultimately fail nonoperative treatment and require surgery can be difficult, but it would improve our ability as orthopedic surgeons to counsel patients.
Who is likely to need surgery for tennis elbow?
A study recently published in the American Journal of Sports Medicine looked at the risk factors for failure of nonoperative treatment of lateral epicondylitis. Elisa J. Knutsen, MD and other researchers at Washington University in St. Louis analyzed 580 patients treated for lateral epicondylitis. 16% ended up having surgery.
The factors that increased a patient’s risk for ultimately undergoing surgery included a duration of symptoms greater than 12 months, a prior injection, the presence of radial tunnel syndrome (a nerve compression in the forearm just below the elbow), prior orthopedic surgery and a workers compensation claim.
Cortisone injections lead to worse outcomes for tennis elbow
Based on this data, it would be reasonable for an orthopedic surgeon to tell a patient he has a 16% chance of nonoperative treatment failing to relieve his pain and ultimately needing surgery. While the risk factors above do not guarantee that he will need surgery, one or more of them could increase his risk.
Knutsen EJ, Calfee RP, Chen RE, Goldfarb CA, Park KW, Osei DA. Factors Associated With Failure of Nonoperative Treatment in Lateral Epicondylitis. Am J Sports Med. Published online June 29, 2015.