logohands

Lateral Epicondylitis of the Humerus (Tennis Elbow)


Lateral epicondylitis, or tennis elbow, is an inflammation of the tendons and muscles arising on the lateral epicondyle, or outside of the elbow joint. It is common, and can lead to considerable discomfort.

diagram Inflammation of tendons, or tendonitis, can have various causes including repetitive use and overuse of the muscles, or direct injury to the region of the elbow. Often the cause is not identifiable. The pain may be from a partial tear of the origin of the muscles which has healed with scar tissue. Scar tissue is less resilient than normal tendon, and can not stretch and accommodate to normal elbow motion as easily.

Signs and Symptoms

diagram The elbow will usually be quite tender along the lateral side (outside). Bending the wrist backwards against resistance may be very painful. Picking up heavy objects with the wrist in a pronated (palm down) position is often painful.

Other problems may be responsible for similar pain, so a thorough examination is necessary to eliminate other ligamentous or muscle damage, pinched nerves in the neck, and other conditions. Sometimes, compression of the radial nerve in the forearm is associated with lateral epicondylitis; the two conditions may be confused, but they may also occur simultaneously.

Treatment

Resting the muscles which insert on the lateral epicondyle may be effective in relieving the pain. This is best done by splinting the wrist, not the elbow, since it is the wrist on which these muscles have their major action. This is often confusing to a patient who wonders why we splint their wrist when the elbow hurts.

If these measures are not effective, a cortisone shot into the lateral epicondyle may help alleviate the inflammation. Change of jobs or recreational activity that is found to exacerbate the discomfort may be necessary. Cortisone shots may be repeated no more than two or three times, since their excessive use may be dangerous to the surrounding muscle and tendon.

If none of these measures alleviate the pain, surgery may help. A number of procedures are available, and the best one depends on the exact nature of the symptoms.

Post-operatively, a compressive dressing will be applied to your elbow and forearm. This dressing and stitches will be removed 10 to 14 days after surgery. If a simple release was performed, elbow motion can resume soon afterwards, but if a more extensive procedure was done, elbow motion may not resume for up to three weeks.

The arm is progressively strengthened after about three weeks, and light activities may be resumed. Heavy activities can be resumed two to six months after surgery, depending on the type of surgery performed.