Lateral Epicondylitis (Tennis Elbow)
Lateral epicondylitis is a degenerative-dystrophic process at the sites of muscle connection to the rounded eminence on a bone. Tennis elbow is accompanied by reactive irritation of adjacent tissues. External lateral epicondylitis happens most often with monotonous movements, and, as a rule, it is normally right-sided. With tennis elbow, the smallest tears occur, which leads to calcification or the development of bursitis.
When lateral epicondylitis occurs, aching is characteristic, which increases when the weight is held in the arm. Most frequently, athletic movements can actually provoke lateral epicondylitis, but it is also frequently provoked by other activities. On palpation in the area of attachment of the tendons, about 1 cm distal to the middle part of the epicondyle, compaction and soreness are noted. In addition, there is a decrease in muscle strength with resistance to grip and with supination of the hand. There are also tests before the treatment, such as chair lift (with arm pronation) and coffee cup test (in which the patient lifts a full cup of coffee). As a rule, aching usually occurs during the tests. Moderate or severe stages of the malfunction may require a surgery.
Initially, it is believed that the tennis elbow arises from an erythrogenic process involving the radial shoulder bag, synovium, periosteum and annular ligament. In 1979, Nirschl and Pettrone described their observations as disorganization of the normal architecture of collagen by fibroblasts, which, with insufficient vasculature in this area, cause a process they called angiofibroblastic hyperplasia, later described as “angiofibroblastic tendinosis.” Over time, scar tissue from these processes replaces normal tissue, which further weakens the tissue and puts it at greater risk of damage. The continuation of this cycle of injuries and imperfect regeneration impair biomechanics, disrupt muscle function and lead to tennis elbow.
Treatment of a Tennis Elbow
In the overwhelming majority of tennis elbow malfunctions (90-95%), the medical care of lateral epicondylitis is carried out traditionally.
Traditional complex treatment includes:
- limiting the load (in the acute stage of tennis elbow, the load on the joint is prohibited);
- massage and physiotherapy;
- internal and external drug treatment;
- wearing an orthopedic device – orthosis;
It is worth noting that for athletes, the severity of lateral epicondylitis may be decreased by changing the racquet.
If traditional treatment is ineffective, surgery is prescribed. Its purpose is to restore muscle biomechanics and eliminate tissue compression.
If traditional treatment carried out within 6-12 months is ineffective, the doctor may recommend an operational intervention.
The choice of the operational treatment is determined by several factors. These are the extent of the lesion, the general health of the patient and his personal requests. Before the treatment, you will discuss all these issues with your doctor.
Open surgery. This is the most applied treatment for tennis elbow. An incision is made in the elbow area. Although such an operation is open, it takes one day.
Arthroscopy. With tennis elbow, intervention is possible using miniature instruments and small accesses. It is also a one-day operation.
Operational risks. As with any surgery, there are inherent risks involved in tennis elbow operation. The widely-spread risks include:
- Damage to blood vessels and nerves;
- Long-term rehabilitation is possible;
- Decreased muscle strength;
- Restricted mobility.
Results from Surgery
After surgery, the elbow joint can be temporarily immobilized with a splint. The stitches and splint are taken off about 1 week after surgery.
After the termination of immobilization, exercises begin to restore movement in the elbow joint. After about 2 months, muscle strengthening exercises are added.
The doctor will discuss with you when you can return to sports. This usually happens 4-6 months after surgery. Operational treatment for tennis elbow is effective for 80-90% of such malfunctions, however, a frequent consequence of surgery is a decrease in muscle strength.
The doctor must take many aspects into account when making a diagnosis of tennis elbow. He will ask about the circumstances in which the tennis elbow occurs and will clarify the location of this issue.
Before the treatment, additional tests may be required to determine the condition of the upper limbs:
- Radiography. The method provides visualization of dense anatomical structures, such as our bones.
- MRI. This method provides good visualization of soft tissues and is used to diagnose tennis elbow and osteoarthritis of the joints of the cervical spine.