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. Cortisone injection at the tendon site is rarely indicated. It does provide short-term relief but tends to cause progressive tear if repeated. On the other hand, Platelet rich plasma (PRP) injection, which is the patient’s own blood centrifuged to augment the platelet concentration and then re-injected at the tendon site, is growing in popularity, providing a 70% plus healing rate. We practice it under ultrasound Imaging in our office, providing there is no prior serious tear at US evaluation of 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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