Lateral Epicondylitis
Tennis Elbow
What is Tennis Elbow (Lateral Epicondylitis?)
Lateral Epicondylitis, commonly known as tennis elbow, is a condition that causes pain on the outside of the elbow. Although it’s often associated with tennis or other racquet sports, it can affect anyone who repeats motions involving the wrist or forearm, such as lifting heavy objects, typing, or certain manual tasks. Over time, stress on the tendons can lead to small tears, resulting in persistent pain and tenderness around the lateral epicondyle, the bony bump on the outer part of the elbow. While it’s sometimes labeled as an “inflammatory” condition, in many cases, especially chronic ones, the problem is more degenerative than inflammatory.
When left unaddressed, tennis elbow can become a chronic source of discomfort. Fortunately, there are several treatment options available, ranging from simple supports (like splints) to more advanced procedures (such as surgery). Below, we outline each method from least invasive to most invasive to help you understand the conservative and surgical routes for managing lateral epicondylitis.
What are the signs and symptoms someone might have tennis elbow (Lateral Epicondylitis)?
Persistent elbow pain that worsens with gripping or lifting
Tenderness on the outer part of your elbow
Stiffness or weakness in the wrist or forearm
Difficulty performing everyday tasks, such as shaking hands or turning a doorknob
How is tennis elbow (Lateral Epicondylitis) diagnosed?
A medical professional—often a hand specialist, or a trained practitioner—will generally make the diagnosis based on:
Physical Examination: Checking for tenderness and pain during certain movements (like resisting wrist extension).
Imaging: In certain cases, an MRI or ultrasound may help confirm tendon damage or rule out other potential causes of elbow pain.
What are the treatment options for tennis elbow (Lateral Epicondylitis)?
Splinting and Anti-Inflammatory Medications
Steroid Injections
PRP (Platelet-Rich Plasma) Injections
Adipose-Derived Stem Cell Injections
Common Extensor Tendon Debridement and Re-Insertion (Surgery)
What is the roll and rational behind splinting and anti-inflammatory medications in the treatment of tennis elbow (Lateral Epicondylitis)?
Splinting (or using an elbow brace) helps support the elbow by redistributing the stress on the forearm muscles and tendons.
Over-the-counter or prescription anti-inflammatory medications, such as NSAIDs (e.g., ibuprofen, naproxen), can help reduce pain and inflammation in the short term.
How It Helps
By limiting certain motions and providing targeted support, a splint can prevent additional strain on the tendon, allowing any microtears to heal.
Anti-inflammatory drugs may alleviate discomfort, making it easier to continue daily tasks and participate in physical therapy if needed.
Considerations
Typically the first line of defense because it’s non-invasive and widely accessible.
Works best if combined with rest, gentle stretching, and potentially a structured exercise plan to strengthen the forearm muscles.
Prolonged use of certain anti-inflammatory medications could worsen or cause gastrointestinal bleeding and should be discussed with a primary healthcare provider to ensure safety.
How do steroid injections treat tennis elbow (Lateral Epicondylitis)?
Steroid injections deliver potent medication near the lateral epicondyle in an effort to reduce pain. However, because tennis elbow (lateral epicondylitis) is largely a degenerative condition—as opposed to a purely inflammatory one—steroids primarily offer a temporary masking of symptoms rather than a true long-term solution.
How It Helps
May provide short-term relief of elbow pain, enabling patients to participate in daily activities or rehab exercises with less discomfort.
Can serve as a bridge therapy for those who need immediate pain alleviation.
Critical Considerations
Does Not Treat Underlying Degeneration: Steroids do not reverse degenerative tendon changes; they only help dampen pain signals.
Potential to Worsen Tendon Damage: Repeated steroid use can hasten the breakdown of the common extensor tendon, potentially leading to weaker tendon structure over time.
Side Effects: Some patients may experience skin bleaching (discoloration) or other adverse effects at the injection site.
Practice Position: Given these drawbacks, we do not routinely recommend steroid injections for all patients. We reserve them for those who clearly understand and acknowledge these potential risks and the limited benefits.
What is the roll of PRP and Stem Cell Therapy for treatment of tennis elbow (Lateral Epicondylitis)?
PRP (Platelet-Rich Plasma) is obtained by drawing a small amount of your blood, separating the platelets, and then injecting that concentrated solution into the affected area.
Stem Cells can be harvested from your own adipose (fat) tissue or sometimes from bone marrow, then concentrated and injected around the damaged tendon.
By offering PRP and Stem Cell Therapy concomitantly, the goal is to utilize each method’s healing properties together, potentially promoting a more robust tissue repair process.
How It Helps
Enhanced Regenerative Effects: PRP provides an abundance of growth factors to stimulate healing, while stem cells may further aid tissue repair by supporting the regrowth of healthy tendon cells.
Addressing Underlying Degeneration: Unlike steroid injections, which mainly mask pain, combined PRP/stem cell treatments target the root cause by attempting to regenerate or strengthen damaged tissue.
Non-Surgical Approach: This can be a viable option for individuals seeking an alternative before considering surgery, especially when splinting, medications, or other conservative measures are not sufficiently effective.
Considerations
Gradual Recovery: Improvements may take several weeks or months to become noticeable because regenerating tendon tissue is a slow process.
Insurance Coverage: Some insurance plans do not cover PRP or stem cell procedures. Patients should verify potential out-of-pocket costs.
Individual Variability: Response to combined PRP/stem cell therapy can differ from person to person, depending on factors such as overall health, extent of tendon degeneration, and adherence to rehabilitation programs.
When used together, PRP and adipose-derived stem cells aim to deliver a powerful, biologically based treatment approach for chronic elbow pain. By supporting the body’s natural repair mechanisms, this combined option may offer longer-lasting relief and help restore function in individuals with tennis elbow who have not responded sufficiently to more conservative methods.
If all conservative measures have been exhausted what is the the roll of surgery for tennis elbow (Lateral Epicondylitis)?
Surgical intervention may be necessary for stubborn or severe cases of tennis elbow that do not respond to other treatments.
The procedure typically involves debriding (removing) diseased or damaged tendon tissue and re-attaching the healthy portion of the tendon to the lateral epicondyle.
How It Helps
Eliminates weakened tissue that is no longer capable of healing on its own.
Re-establishes a secure connection between the tendon and the bone, promoting stronger, long-term function.
Considerations
A period of rehabilitation (including physical therapy) is crucial to regain strength and range of motion.
Most patients experience significant pain relief and improved function post-surgery, though full recovery can take several months.
Frequently Asked Questions
1. How long should I try conservative treatments before considering surgery?
Many people experience relief within 6–12 weeks of consistent use of splinting, anti-inflammatory medications, and physical therapy. If you have persistent elbow pain after a few months, it may be appropriate to consider more advanced options such as PRP, stem cells, or surgical intervention.
2. Are PRP and stem cell injections painful?
The procedure can cause some mild to moderate discomfort, but most patients tolerate it well. Local anesthesia and ultrasound guidance help minimize pain and ensure precise placement of the healing factors into the damaged area.
3. Can tennis elbow return after successful treatment?
Yes. Reinjury can occur if the tendon is overused again. Adhering to rehabilitation guidelines, proper ergonomics, and a gradual increase in activities can help reduce the risk of recurrence.
4. How successful is surgery for tennis elbow?
Surgery has a high success rate for the right candidates. Most patients achieve long-term pain relief and functional improvement when combined with adequate postoperative rehab.
Disclaimer: The information provided here is meant for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider to determine the most appropriate treatment plan for your specific condition.