Tennis Elbow

Introduction

Tennis elbow is a painful condition that occurs when tendons in your elbow are overworked, usually by repetitive motions of the wrist and arm. Tennis elbow can result from poor technique in executing a tennis backhand. However, many occupations also feature repetitive wrist and arm motions that can cause tennis elbow.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to the bony prominence on the outside of your elbow. Pain can also spread into your forearm and wrist.

Rest and over-the-counter pain relievers often help relieve tennis elbow. If conservative treatments don't help or if symptoms are disabling, your doctor may suggest surgery.

When is Tennis Elbow Surgery recommended?

The pain associated with tennis elbow may radiate from the outside of your elbow into your forearm and wrist. Pain and weakness may make it difficult to:

  • Shake hands

  • Turn a doorknob

  • Hold a coffee cup

Talk to your doctor if self-care steps such as rest, ice and use of over-the-counter pain relievers don't ease your elbow pain and tenderness

What are the causes?

Tennis elbow (lateral epicondylitis) is an overuse and muscle strain injury. The cause is repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in inflammation or a series of tiny tears in the tendons that attach the forearm muscles to the bony prominence at the outside of your elbow (lateral epicondyle).

As the name suggests, playing tennis — especially repeated use of the backhand stroke with poor technique — is one possible cause of tennis elbow. However, many other common arm motions can cause tennis elbow, including:

  • Using plumbing tools

  • Painting

  • Driving screws

  • Cutting up cooking ingredients, particularly meat

  • Excessive computer mouse use

How is Tennis Elbow diagnosed?

In many cases, your medical history and the physical exam provides enough information for your doctor to make a diagnosis of tennis elbow. But if your doctor suspects that something else may be causing your symptoms, he or she may suggest:

  • X-rays. An X-ray can help your doctor rule out other possible causes of elbow pain, such as a fracture or arthritis.

  • Magnetic resonance imaging (MRI). Problems in your neck can sometimes cause symptoms similar to tennis elbow. MRI machines use radio waves and a strong magnetic field to produce detailed images of bones and soft tissues.

  • Electromyography (EMG). This type of test can check to see if your symptoms are linked to a pinched nerve. During an EMG, fine wires are inserted into a muscle to assess electrical changes that occur when the muscle moves.

What are the treatment options for Tennis Elbow?

Tennis elbow often gets better on its own. But if over-the-counter pain medications and other self-care measures aren't helping, your doctor may suggest physical therapy. Severe cases of tennis elbow may require surgery.

Therapy

  • Learn proper form. Your doctor may suggest that experts evaluate your tennis technique or job tasks to determine the best steps to reduce stress on your injured tissue. This may mean going to a two-handed backhand in tennis or taking ergonomic steps at work to ensure that your wrist and forearm movements don't continue to contribute to your symptoms.

  • Exercises. Your doctor or a physical therapist may suggest exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm.

  • Braces. Your doctor may also suggest you wear a forearm strap or brace to reduce stress on the injured tissue.

Surgery
If your symptoms haven't improved after at least a year of extensive conservative therapy, you may be a candidate for surgery to remove damaged tissue. These types of procedures can be performed through a large incision or through several small incisions. Rehabilitation exercises are crucial to recovery.

What are the risk factors for Tennis Elbow?

Factors that may increase your risk of tennis elbow include:

  • Age. While tennis elbow affects people of all ages, it's most common in adults between the ages of 30 and 50.

  • Occupation. People who have jobs that involve repetitive motions of the wrist and arm are more likely to develop tennis elbow. Examples include plumbers, painters, carpenters, butchers and cooks.

  • Certain sports. Participating in racket sports increases your risk of tennis elbow, especially if you employ poor stroke technique.

Can Tennis Elbow be prevented?

The best way to prevent tennis elbow is to stretch and strengthen your arm muscles so that they are flexible and strong enough for your activities. Try:

Other ways to prevent tennis elbow include:

  • Staying in good overall physical shape.

  • Using the correct techniques and movements during activities.

  • Using equipment appropriate for your ability, body size, and body strength.

  • Not overusing your arm with repeated movements that can injure your tendon. For example, alternate hands during activities, if possible.

  • Strengthening the muscles of your arm, shoulder, and upper back to help take stress off of your elbow.

  • Wearing a counterforce brace during activities that require grasping or twisting arm movements. A counterforce brace is a strap worn around your forearm just below your elbow. This brace may distribute pressure from muscle use throughout the arm, easing pressure on the tendon. The brace is not usually used for prevention. But it may be recommended for someone who is at very high risk for tennis elbow. Talk to your doctor if you are thinking of using one of these braces for prevention. A counterforce brace is not a substitute for rehab exercises or an excuse to continue overuse activities.

If you feel that certain activities at your job are causing elbow pain or soreness, talk to your human resources department for information on other ways of doing your job. They can help with changes to equipment or other job assignments.

Consider taking lessons to learn the proper technique for sports, such as tennis and golf, that require grasping and twisting motions in the arm. Have a sports trainer or a person who is familiar with sports equipment check yours to make sure it suits your level of ability, body size, and body strength.

In daily routines or hobbies, look for activities that use repeated arm movements that strain your fingers, wrist, or forearm, such as in gardening, cooking, or playing musical instruments. Train yourself to use techniques that won't stress your elbow. For example, when you lift objects, lift with the palm of your hand facing upwards.

How fast can you recover?

To be shared by the doctor.

After Discharge?

Post-Op through Week 1

Pain Control

Medication for pain: Percocet which is a short acting pain medication and taken one or two pills every 3 to 4 hours as needed

We will call you at home the day after your surgery to see how you are doing and to answer any questions you might have.  At that time we will as to set up your follow-up visit if not previously scheduled.

Hospital Visit

The first Post Operative visit will take place the week following surgery. At that time, sutures are removed, exercises reviewed, and physical therapy, if appropriate, scheduled. Exercises as well as more detailed instructions and return to school or work will be reviewed at that time. 

Showering

You can place a garbage bag over your arm securing it with tape or rubber band.  Hold your arm over your head to insure no water runs in.  When your splint is removed and sutures removed you may shower normally.

Sling

Adjust your sling to comfort to best support your shoulder. Neck, wrist and arm straps should not be too tight.  Right away (even in the hospital) it is permissible to loosen your sling and bend and straighten your elbow, wrist and fingers. After a day or two you may remove your sling completely or for long periods.

1. Release wrist strap and exercise fingers wrist and elbow
2. When lying down place a pillow behind your elbow for comfort
3. Begin moving your shoulder as soon as possible
4. Extend your elbow each day until the arm is completely straight

 Please call the hospital if you have temperature greater than 101, degrees difficulty voiding or shortness of breath.  Staining of the dressing is expected.

What are the results of the surgery?

Overall, 90% to 95% of people with tennis elbow will improve and recover with the treatment plan described. However, about 5% of people will not get better with conservative treatment and will need surgery to repair the injured muscle-tendon unit around the elbow. For 80% to 90% of people who have surgery, it results in pain relief and return of strength.

What are the complications?

Left untreated, tennis elbow can result in chronic pain — especially when lifting or gripping objects. Using your arm too strenuously before your elbow has healed can make the problem worse.

Cost of Surgery?

The cost of surgery for Tennis Elbow depends on many factors. They include the cost of being in the hospital for several days. Unexpected events that result in an extended hospital stay will also increase the overall cost.

Costs also vary depending on the type of insurance coverage you have. Many insurance companies cover the cost of the surgery, the hospital stay, and the instruments to straighten the spine. You may owe a co-payment or you may be billed the balance of what your insurance does not cover.

Be sure to contact your insurance provider prior to surgery to discuss the extent of your coverage. Discuss with your surgeon, as well as the hospital billing department to make sure you understand all the costs involved.

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