The elbow is primarily a hinged joint, capable if bending and extending. It also has a rotation component as well. The joint is held in place with a complex arrangements of ligaments and surrounded by multiple nerves, muscles, and blood vessels. The elbow also has an intimate association with the wrist and hand since the muscles that govern wrist and hand movement have their origin at the elbow.
The two major muscle groups that permit movement of the wrist and hand are the flexors (help the hand make a fist and help the wrist to bend downward) and the extensors (help the fingers to extend and the wrist to bend upward).
The flexors have their origin at the medial epicondyle (inside bony protuberance) and extensors have their origin at the lateral epicondyle (outside bony protuberance). The muscle origin attachment for the flexor muscle group is called the common flexor origin and the muscle origin attachment for the extensor muscle group is called the common extensor origin.
This article will discuss lateral epicondylitis- a disorder that occurs at the outside of the elbow.
Lateral epicondylitis (LE) is a common disorder that is often referred to as “tennis elbow.” Interestingly, most people who develop this affliction don’t play tennis. Overuse is probably the most common cause, but sometimes minor trauma also plays a role. Many people say, it just began with no history of antecedent overuse or trauma. Gardeners are particularly at risk.
Pain is located directly at the lateral epicondyle or perhaps a bit more distal. The discomfort is aggravated by such activities as shaking hands, lifting a bag, or even getting milk out of the refrigerator.
The “itis” suffix indicates that inflammation plays a prominent role. However, most people, particularly those in their 30’s or older do not have inflammation as the underlying problem. Rather, what is seen is tendon degeneration involving the common extensor tendon group. The most common tendon affected is what is called the extensor carpi radialis brevis.
Treatment of the disorder is straightforward. Rest, limitation of the activities, and symptomatic relief are the treatments which are usually used first. Ice, moist heat, and either analgesics or non-steroidal anti-inflammatory drugs (NSAIDS) to help with pain sometimes are helpful. The NSAIDS are used for their analgesic properties, not their anti-inflammatory properties per se.
A “tennis elbow” brace, specific stretching exercises, ultrasound administered by a physical therapist, and a single localized ultrasound guided steroid injection can sometimes provide relief. The steroid injection is problematic because local inflammation is not the issue and the steroid can further weaken the already degenerated tendon.
An MRI can also determine if there is a small tear present if the patient doesn’t get better. Entrapment of the radial nerve (radial tunnel syndrome), and tendinopathy of the distal biceps tendon can both mimic LE.
Patients who don’t respond to conservative measures usually will improve with ultrasound-guided percutaneous needle tenotomy accompanied by platelet-rich plasma (PRP). PRP is a concentrate of a patient’s blood which contains a large number of platelets, cells that have many growth and healing factors. This procedure actually builds new tendon tissue and is considered the procedure of choice now for severe chronic LE.