Tennis Elbow Treatment

What is Tennis Elbow?

Tennis elbow, medically known as lateral epicondylitis, is a painful condition that occurs when the tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm. Despite its name, athletes aren't the only people who develop tennis elbow. Anyone whose activities involve repetitive wrist and arm motions can develop this painful condition, including plumbers, painters, carpenters, and butchers.

Types and Causes of Tennis Elbow

Understanding Tennis Elbow

• Acute Tennis Elbow: Develops suddenly, often due to a specific incident or injury.
• Chronic Tennis Elbow: Develops gradually over time, usually from repetitive motions.
• Mild to Severe: Ranges from occasional discomfort during activities to constant pain that interferes with daily tasks.

Common Causes

• Repetitive Motion: The primary cause is overuse from repetitive wrist and arm movements, causing small tears in the tendon.
• Sports Activities: Tennis, racquetball, squash, fencing, and weight lifting can all contribute to this condition.
• Occupational Activities: Painting, plumbing, carpentry, typing, cooking, and other jobs that involve repetitive arm movements.
• Age Factor: Most common in adults between 30 and 50 years old.
• Improper Technique: Using poor form during sporting activities or work tasks that put extra stress on the tendons.
• Inadequate Equipment: Using tools or sports equipment that are too heavy or have grips that are too large or small.

Symptoms and Diagnosis

Common Symptoms

• Pain and burning on the outer part of the elbow, which may gradually worsen
• Weak grip strength
• Pain that worsens with forearm activities like holding a racquet, turning a wrench, or shaking hands
• Pain that radiates from the outside of the elbow into the forearm and wrist
• Difficulty extending your arm fully
• Morning stiffness or pain when trying to make a fist
• Pain when lifting objects, opening doors, or raising your hand

Diagnostic Process

Dr. Saxena employs a comprehensive approach to diagnose tennis elbow:

• Physical Examination: Dr. Saxena will check for tenderness at the lateral epicondyle (outer part of the elbow) and may perform specific tests that put stress on the affected tendons to reproduce symptoms.
• Imaging Studies:
  • X-rays: To rule out arthritis or other bone problems
  • MRI: May be ordered in cases where symptoms don't improve or to rule out other conditions
  • Ultrasound: Can visualize tendon damage and inflammation in real-time
• Electromyography (EMG): In some cases, to exclude nerve compression syndromes like radial tunnel syndrome.

Treatment Options

Dr. Abhishek Saxena develops personalized treatment plans based on the severity of the condition, duration of symptoms, and the patient's lifestyle and activity requirements. Treatment options include:

Non-Surgical Management

• Rest and Activity Modification: Avoiding activities that worsen symptoms and modifying techniques to reduce strain.
• Physical Therapy: Specific exercises to stretch and strengthen the forearm muscles, improving flexibility and gradually building tendon resilience.
• Bracing: Counter-force braces or tennis elbow straps help reduce strain on the injured tendon by redirecting forces away from the injured area.
• Anti-inflammatory Medications: NSAIDs to reduce pain and inflammation.
• Corticosteroid Injections: May provide temporary relief for severe pain, though limited in number due to potential tendon weakening with repeated use.
• PRP (Platelet-Rich Plasma) Therapy: Utilizing the body's own healing factors to promote tissue repair.
• Extracorporeal Shock Wave Therapy (ESWT): Sound waves stimulate healing in the affected tendon.

Non-surgical approaches are successful in approximately 80-95% of cases, especially when started early. Most patients see improvement within 6-12 weeks with appropriate treatment.

Surgical Management

Surgery may be recommended when:

• Symptoms persist for 6-12 months despite conservative treatment
• Pain significantly interferes with daily activities and sleep
• Conservative measures provide limited or temporary relief
• The patient has occupational demands that cannot accommodate prolonged conservative treatment

Dr. Saxena specializes in various surgical techniques:

• Open Surgery: Traditional approach involving an incision over the elbow to remove damaged tissue and reattach healthy muscle to bone.
• Arthroscopic Surgery: Minimally invasive approach using small incisions and a camera to guide the removal of damaged tissue.
• Percutaneous Tenotomy: A technique where the damaged portion of the tendon is released through a small incision.
• TENEX Procedure: Ultrasound-guided removal of damaged tissue using specialized equipment.

Our Advanced Surgical Approach

Dr. Saxena utilizes state-of-the-art techniques for tennis elbow treatment:

• Minimally invasive arthroscopic techniques for faster recovery and less scarring
• Precise identification and removal of only the diseased tissue, preserving healthy structures
• Advanced imaging guidance for improved accuracy
• Combined approaches addressing both the tendon pathology and any associated conditions
• Biologic augmentation with platelet-rich plasma when appropriate
• Customized surgical planning based on the specific nature of the tendon damage and patient factors

The Surgical Experience

Tennis elbow surgery is typically performed as an outpatient procedure, meaning you can go home the same day. The procedure is usually carried out under regional anesthesia (numbing just the arm) or sometimes with general anesthesia.

For arthroscopic surgery, Dr. Saxena makes several small incisions around the elbow. Through these portals, a camera and specialized instruments are inserted to identify and remove damaged tissue. The procedure typically takes 30-60 minutes.

After surgery, your arm will be bandaged and possibly placed in a splint temporarily. Pain management protocols, including appropriate medications, help ensure comfort during the initial recovery period. Most patients can return home within a few hours after the procedure.

Recovery and Rehabilitation

Recovery from tennis elbow treatment varies depending on the severity of the condition and the type of treatment received:

• Initial Recovery (0-2 weeks): Rest, ice, protection of the surgical site, and limited activities. A splint may be used briefly.
• Early Rehabilitation (2-6 weeks): Gentle range of motion exercises begin, with gradual progression to light strengthening as healing progresses.
• Strengthening Phase (6-12 weeks): Progressive resistance exercises targeting the wrist extensors and forearm muscles.
• Return to Activity (3-6 months): Gradual return to sports and occupational activities with proper technique and equipment modifications if necessary.

Dr. Saxena and his team provide a customized rehabilitation protocol for each patient, with regular follow-up appointments to monitor progress. Full recovery may take 4-6 months, though many patients notice significant improvement in symptoms much earlier.

Outcomes and Success Rates

Treatment for tennis elbow generally has very good outcomes:

• 80-95% of patients improve with non-surgical treatment alone
• Surgical treatment has a success rate of approximately 85-90%
• Most patients experience significant or complete pain relief
• Return to previous work and recreational activities is possible for the vast majority of patients
• Recurrence rates are low when proper technique modifications and preventive measures are adopted

Factors that influence outcomes include duration of symptoms before treatment, severity of tendon damage, patient age, compliance with rehabilitation, and willingness to modify activities or techniques that contributed to the condition.

Prevention Strategies

To prevent tennis elbow or its recurrence, Dr. Saxena recommends:

• Proper warm-up before activities that use the arms and wrists
• Strengthening forearm muscles with specific exercises
• Using proper technique in sports and occupational activities
• Ensuring equipment is properly sized and not too heavy (racquets, tools)
• Taking breaks during repetitive activities
• Using ergonomically designed tools and equipment
• Wearing a counterforce brace during activities that stress the forearm
• Stretching the forearm muscles regularly, especially before and after activities

Dr. Saxena can provide personalized recommendations for prevention based on your specific activities and risk factors.