Tennis elbow (lateral epicondylitis) involves the inflammation or degeneration of the tendons connecting the forearm muscles to the lateral epicondyle, the bony prominence on the outside of the elbow. This overuse injury is caused by repetitive wrist extension and gripping, which micro-tears the extensor carpi radialis brevis (ECRB) tendon. Although the name suggests a link to racquet sports, most people acquire it through professional or recreational activities requiring repetitive arm motions. Effective management usually involves a collaborative approach utilizing various healthcare providers.
Initial Diagnosis and Referral
Treatment typically begins with a primary care physician (PCP), internal medicine doctor, or general practitioner. This doctor performs an initial consultation, including a detailed medical history and a physical examination to localize the pain and assess the injury. The physician tests for pain upon resistance when extending the wrist and fingers, a classic indicator of lateral epicondylitis.
The initial assessment involves ruling out conditions that mimic tennis elbow, such as nerve compression or radial tunnel syndrome. The PCP may order diagnostic imaging, like an X-ray to exclude arthritis or an MRI to check for tendon damage. Once confirmed, the provider initiates basic conservative treatments such as rest, activity modification, and over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) before referring the patient to a specialist.
Non-Surgical Management Specialists
Most tennis elbow cases (80 to 95%) are resolved without surgery, relying on specialized non-surgical care managed by specialists focused on musculoskeletal function and pain. Non-surgical sports medicine physicians, trained in activity-related injuries, refine the diagnosis and offer advanced treatments.
These specialists administer advanced non-operative treatments, such as ultrasound-guided injections. Examples include platelet-rich plasma (PRP) therapy to promote tissue healing, or corticosteroid injections to manage inflammation and pain. Physiatrists, specializing in Physical Medicine and Rehabilitation (PM&R), develop comprehensive, long-term rehabilitation plans focused on restoring function.
Physical therapists (PTs) implement the rehabilitation plan through hands-on treatment and patient education. A PT guides the patient through specific exercises designed to strengthen the forearm muscles and tendons (ECRB) and improve flexibility. They also provide manual therapy techniques and ergonomic correction, adjusting the patient’s form during work or sport to prevent recurrence.
The Surgical Option
Surgical intervention is reserved for patients whose symptoms have not improved after six to twelve months of specialized non-surgical treatment. If conservative methods fail, the patient is referred to an orthopedic surgeon, who performs operative procedures on the elbow.
The primary goal of surgery is to remove the damaged or degenerated tissue (debridement). The surgeon may perform this through open surgery (a small incision) or an arthroscopic procedure (using smaller cuts and a camera). The surgeon then reattaches the healthy portion of the tendon to the bone or uses techniques like ultrasonic tenotomy to stimulate healing.
The orthopedic surgeon oversees initial post-operative care, including immobilization and pain management, before transitioning the patient back to physical therapy. Post-surgical rehabilitation is necessary for regaining full strength and range of motion.