WHAT YOU SHOULD KNOW
This condition has many names including lateral epicondylitis or tennis elbow. There is a much less common version on the inside of the elbow often called medial epicondylitis. The muscles in the forearm involved with gripping have a thick band inside them that doesn’t stretch at all. Overuse or misuse of these muscles causes excessive traction and minor tearing on the muscle attachment point at the elbow. Also tension in the muscle causes the thick band to put pressure on a nerve that runs underneath the muscle. Although the patient doesn’t know it, he or she is probably using the arm the wrong way and needs to develop ergonomically correct habits. See also Radial Tunnel Syndrome.
MEDICAL HISTORY: Sharp pain at the side of the elbow and aching pain in the forearm are the main symptoms that are usually made worse by gripping or trying to lift anything. When advanced, it can even be difficult to straighten the elbow.
EXAMINATION: The outside of the elbow and the upper forearm are tender to applied pressure. Cocking the wrist or fingers back against resistance is painful. Stretching the muscle or straightening the elbow can be difficult.
ADDITIONAL TESTS: None are needed.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL RELEASE | |
| CONSISTS OF | Stretching, muscle conditioning and ergonomic training | Dividing the thick band while leaving the muscle alone |
| FEATURES | Makes the muscle group more elastic with less pressure on nerve and less tension on attachment point | Short incision, outpatient, immediate use for light activities |
| ADVANTAGES | Avoids surgery | Definitive solution to problem |
| DISADVANTAGES | Only works on muscle tissue, if band is too thick will not be successful | Temporary period of weakness where arm cannot be used for heavy activity |
RECOVERY
Light everyday activities are allowed immediately. Sutures are removed in the office at 2 weeks. Rehabilitation begins soon after surgery with the same stretching exercises done during the non-operative treatment program. Strengthening comes next along with endurance as the patient prepares to return to heavy activities. Powerful use of the arm doesn’t usually occur until several months after surgery as the healing tissues become more mature.
