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Dr MARC BEAUCHAMP MD FRCSC
Private orthopedic surgery clinic, Montreal, Canada Shoulder and elbow surgery, arthroscopy
Private orthopedic surgery Montreal, Canada
Elbow Elbow anatomyCommon problemsTendinitis of the elbow, lateral epicondylitisTendinitis of the elbow, medial epicondylitisTendinitis of the elbow, distal bicepsOsteoarthritis of the elbow
Shoulder anatomy

Tendinitis of the elbow – Lateral epicondylitis (tennis elbow)

Very common and rarely caused by playing tennis, lateral epicondylitis affects the attachment point of the short extensor muscles on the radius and of the finger extensors on the lateral epicondyle of the distal humerus. The tendon degenerates either from overuse (e.g., sports, work) or due to "personal" reasons. Tendon tears may occur.

Healing occurs on its own in 90% to 95% of patients. There are a number of conservative treatments: rest, orthotic devices, oral anti-inflammatories, cryotherapy, physiotherapy, occupational therapy, acupuncture, shock wave therapy, etc. While cortisone injections are very effective, they must be used sparingly, for more than three injections may damage the tendon.

If the pain is not resolved after six months of treatment (some people prefer to wait 12 months), further investigation is warranted. An MRI scan or ultrasound will be able to show a tear or the severity of the tendinopathy.

When conservative treatment fails, surgery is the solution. The procedure has a bad reputation that is totally unfounded: serious studies have in fact shown that the success rate approaches 85% or 90% if the correct diagnosis is made in the first place. Healing, which varies from person to person, takes three to five months.

There are a number of surgical techniques. The technique I have been using for several years is performed under local anesthesia (as used by dentists) and involves the release of the epicondyle tendon which then forms scar tissue and attaches to its intact neighbour: the long wrist extensor. The elbow is mobilized the next day so that healing occurs without excessive tension in the arc of movement. Physiotherapy is rarely necessary and complications (infections, stiffness, neurological or vascular lesions) are infrequent.

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