Ace the Pain, Not Your Game: Understanding and Treating Tennis Elbow (Lateral Epicondylitis)
By Dr. Oren Michaeli, DO
Board Certified General Surgeon | Fellowship-Trained in Hand Surgery, Microsurgery, and Peripheral Nerve Surgery
Tennis elbow, also known as lateral epicondylitis, is a condition that causes pain and tenderness on the outside of the elbow. While it often strikes athletes, notably tennis players, it can affect anyone who performs repetitive wrist or hand movements—including office workers, musicians, and manual laborers. As a Board-Certified Surgeon with a focus on hand, nerve, and microsurgery, I’ve encountered tennis elbow in a wide variety of patients and have guided them toward relief through both conservative and innovative treatments. Below is an in-depth look at this condition, its causes, and the best approaches for lasting recovery.
What Is Tennis Elbow?
Tennis elbow occurs when the extensor tendons that attach to the lateral epicondyle (the outer bony prominence of the elbow) become overused or stressed, leading to microtears, inflammation, and pain. Despite its name, you don’t need to swing a racket to develop this issue—any activity involving frequent wrist extension or gripping can trigger symptoms.
Typical Symptoms: Persistent pain on the outer elbow, pain when gripping or lifting objects, and sometimes reduced grip strength.
Microscopic Tendon Damage: Repetitive strain creates microtears in the tendon, which can eventually lead to more significant damage if untreated.
Conservative Treatments: A Starting Point
Activity Modification
Limiting or adjusting the repetitive motions causing strain can give the tendon time to heal.
Ergonomic changes (e.g., adjusting desk setup or modifying tennis technique) can help alleviate stress on the elbow.
Physical Therapy
Targeted exercises to strengthen forearm muscles and promote proper biomechanics.
Gradual progression from gentle range-of-motion exercises to strengthening routines.
Bracing or Splinting
An elbow strap can help distribute force away from the injured tendon.
Wrist splints may also be used to minimize certain movements that aggravate the elbow.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Can reduce inflammation and pain in the short term.
Not a long-term fix, as they address symptoms rather than underlying tendon damage.
Why I Avoid Steroid Injections
While steroid injections remain a common treatment for tennis elbow, I do not use them in my practice. Steroids may temporarily decrease inflammation and pain, but they do not address the root cause of tendon degeneration. Repeated or high-dose steroid use can:
Mask Underlying Damage: Patients may overuse the arm once pain subsides, leading to further damage.
Weaken Tendons: Long-term or repeated use of steroids can degrade tendon structure, potentially increasing the risk of rupture.
Short-Lived Relief: Symptoms often return once the steroid wears off, leading to a cycle of dependency without true healing.
A Modern Approach: Fat Grafting & Stem Cell Therapy
For individuals who do not improve with conservative measures, I offer fat grafting stem cell therapy to promote tendon healing from within. This method uses the body’s own regenerative capabilities to combat chronic tendon damage.
Harvesting Fat: A small amount of fat tissue is gently removed from an area such as the abdomen or thigh.
Processing & Concentration: This fat is processed to concentrate stem cells and other growth factors.
Precise Injection: The processed cells are injected directly into the damaged segment of the extensor tendon, aiming to rebuild and strengthen the tissue rather than merely reduce inflammation.
Advantages of Fat Grafting & Stem Cell Therapy
Regenerative Focus: Unlike steroids, which can weaken tendons, stem cells aim to stimulate tissue repair and growth.
Autologous & Safe: Because we use your own tissue, there’s minimal risk of rejection or allergic reaction.
Long-Term Potential: Encourages the tendon to heal itself, which may offer more durable relief from pain and dysfunction.
Surgical Intervention: Reinsertion or Repair
In some cases, especially when significant tendon damage or chronic pain persists despite conservative therapy and regenerative treatments, surgery may be necessary. A surgical approach for tennis elbow often includes:
Debridement: Removing damaged or degenerative tendon tissue.
Reinsertion: Reattaching healthy tendon tissue to the lateral epicondyle.
Specialized Techniques: My background in microsurgery and peripheral nerve surgery ensures careful protection of nerve and blood vessel structures surrounding the elbow.
What to Expect Post-Surgery
Recovery Timeline: Several weeks to months of healing, with a structured physical therapy regimen to restore strength and flexibility.
Gradual Return: Although you may resume light activities relatively soon, a full return to high-demand activities can take longer to ensure the tendon fully repairs.
Recovery and Prevention
No matter the chosen treatment path—conservative, regenerative, or surgical—proper rehabilitation is critical. Many patients experience the best outcomes when they commit to:
Consistent Physical Therapy: This aids in strengthening the forearm muscles and improving joint mobility.
Patience & Gradual Progression: Avoid jumping back into strenuous activities immediately, as this can re-injure the tendon.
Ergonomic Evaluation: Whether it’s adjusting your tennis swing or reconfiguring your workstation, proper technique and setup can drastically reduce tendon strain.
Comprehensive, Individualized Care
At my practice, Hand, Nerve & Microsurgery PC, located at 570 Sylvan Ave 2nd Floor, Englewood Cliffs, NJ 07632, every treatment plan is tailored to the patient’s unique presentation. From noninvasive therapies to advanced fat grafting stem cell treatments and surgical intervention, my goal is to identify the most effective approach for each individual. If you or a loved one is suffering from tennis elbow, please contact me at (917) 993-3353 or Info@handnervemicrosurgery.com, or visit my website at HandNerveMicrosurgery.com to learn more.
Key Takeaways
Tennis elbow (lateral epicondylitis) often arises from repetitive forearm and wrist movements, causing microtears in the extensor tendon.
Conservative methods—such as rest, physical therapy, and bracing—form the first line of treatment.
Steroid injections can offer temporary relief but may pose long-term risks, including tendon weakening.
Fat grafting stem cell therapy harnesses the body’s natural healing mechanisms, promoting true tendon regeneration.
Surgical options exist for severe cases, focusing on removing damaged tissue and reattaching the tendon to the elbow.
