Have you been experiencing sudden onset elbow pain? Well, you may be suffering from a condition known as lateral epicondylitis of the elbow, also commonly known as the tennis elbow!
This condition is caused due to repetitive use of a group of forearm muscles attached to the bony prominence of your elbow. The excessive pull of this common extensor origin gives rise to irritation and inflammatory response at the bony prominence (lateral epicondyle of the elbow). This condition is common in sportsmen who use racquets, like tennis and badminton, however, even simple day-to-day activities like wringing can also cause inflammation of the attachment of the muscle origins. Tennis elbow is also common in carpenters, plumbers, painters, and people who need screwing movements of the forearm. With the work from home and excessive use of computers and laptops, the incidence of tennis elbow has increased significantly.
The tennis elbow presents as a pain on the outer aspect of the bony prominence of your elbow. This typically can increase with day-to-day activities or exercises. Pain may gradually increase if you continue the activities and maybe chronic and nagging in some individuals. Rarely they may present with localized swelling and/or redness around the elbow. There is various other conditions in the elbow that mimic the tennis elbow and hence make sure that you consult your Orthopaedic Surgeon before you initiate the treatment.
The treatment often begins with careful examination of the elbow joint by your doctor. The diagnosis is more often than not clinical, and the initial conservative treatment can be started. The early treatment usually comprises of four simple steps (Rest, Cryotherapy/ Cold Fomentation, Compression, and Bracing). Activity management should be done to reduce the triggering mechanisms. Cold fomentation in the form of ice packs or cryotherapy aids in reducing inflammation and pain. Cold fomentation can be done for 20-30 mins three to four times a day. Nowadays, we do have a variety of braces available in the market for tennis elbow, primarily reducing the activity and the traction of the forearm muscles, and patients should use them in the initial stages to reduce the pain progression. Medical management is started in the form of NSAIDs if the pain is severe and more often than not, the condition subsides with these simple modalities. If you have a desk job for long hours, then you must make sure that you have the correct posture when you are working. Make sure that you have better ergonomics and a comfortable position to rest your palms and forearm to reduce the chances of tennis elbow.
Sometimes, even after the initial treatment, the pain may persist or may increase in intensity. In such a situation, your doctor may prescribe you further radiological investigation to aid the diagnosis process. Ultrasound examination and MRI (Magnetic Resonance Imaging) scans are useful to detect the presence of swelling in the common extensor region.
Physiotherapy modalities may be useful in reducing the inflammatory response and pain. Gradual eccentric strengthening exercises can be started initially. If pain persists, then your Orthopaedician may suggest you proceed with local injection therapy. This injection can be given in the OPD in the region of the common extensor origin or, it can also be given under the Ultrasound guidance to target the spot precisely. The injection may comprise of a combination of local anesthetic agents and asteroids. Your doctor may also inject the area with newer combinations like PRP (Platelet Rich Plasma) or Stem Cell Therapy. The injection therapy can be aimed at reduction of the local inflammation and to generate a healing response at the site of pain. You may need to repeat the injection after 6 weeks to 8 weeks. Rest, cold fomentation, and bracing should be continued even after the injection is administered.
In the opinion of Dr. Abhishek Nerurkar, Consultant Orthopaedic Surgeon, P.D. Hinduja Hospital, Khar and S.L. Raheja Fortis, Mumbai, most of the patients will be able to recover from tennis elbow with conservative treatment. But in those who still experience discomfort and pain, we may have to resort to operative treatment modalities. The surgery is mainly aimed at releasing a specific set of muscles that cause the tennis elbow. With the advancement of surgical techniques, this can also be done by minimally invasive techniques and endoscopy. Such techniques target the affected area selectively and all the inflamed tissue is removed. The tendon origins are released leading to a reduction in pain and swelling of the elbow.
After the treatment, patients can expect to get back their full and painless range of movement. There is a significant reduction in elbow pain. The grip and forearm strength gradually improve with the physiotherapy and rehabilitation program. Sportsmen can get back to their competitive sports after the complete recovery which maybe around 4 months to 8 months depending on the severity of the disease. The secret to complete recovery is to have patience when you are taking the treatment, follow your doctor’s advice religiously, and don’t push yourself hard till the recovery is complete.
Dr. Abhishek Arun Nerurkar, M.S. Orthopaedics., D.N.B. Orthopaedics.,
F. Sports Medicine and Arthroscopy, Germany, F. Advanced Hip and Knee Joint Reconstruction (SICOT),
Consultant Orthopaedic Surgeon P.D. Hinduja Hospital, Khar SL Raheja Fortis, Mahim Surya Hospitals, Santacruz
Holy Spirit Hospital, Andheri East Specialist in Shoulder and Knee Surgeries (Arthroscopy and Arthroplasty)