Tennis elbow, known medically as lateral epicondylitis, is a common condition that causes pain on the outside of the elbow. This overuse injury results from repetitive motions of the wrist and arm, often occurring in people who do not play tennis, such as painters or plumbers. It involves the inflammation or degeneration of the tendons, specifically the extensor carpi radialis brevis (ECRB) tendon, connecting the forearm muscles to the humerus bone at the lateral epicondyle.
Starting with Primary Care
The initial point of contact for most patients experiencing elbow pain should be a primary care physician (PCP), such as a Family Practitioner, Internist, or General Practitioner. These physicians are trained to conduct a physical examination, take a medical history, and accurately diagnose musculoskeletal conditions like tennis elbow. They will also help rule out other potential causes of elbow pain, such as nerve compression or arthritis.
PCPs manage the initial, conservative treatment plan, which is sufficient for most mild cases. This often includes recommending rest, applying ice, and taking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to manage pain and swelling. They may also prescribe a basic counterforce brace to reduce strain on the tendon during daily activities. If symptoms persist despite these initial measures, the PCP coordinates further care by providing a referral to a specialist.
Physicians for Advanced Treatment
When conservative measures fail to provide relief after several weeks or months, a referral to a specialist is warranted. The type of specialist depends on the preferred treatment path—surgical or non-surgical intervention.
Orthopedic Surgeons
Orthopedic Surgeons specialize in the diagnosis and treatment of conditions affecting the musculoskeletal system and handle the most severe or chronic cases. While they are the experts for surgical intervention, they also manage non-surgical options like corticosteroid injections to temporarily reduce severe pain. If surgery becomes necessary, they perform procedures such as open or arthroscopic debridement to remove damaged tendon tissue or reattach healthy portions of the tendon to the bone.
Sports Medicine Physicians and Physiatrists
Sports Medicine Physicians and Physiatrists (Physical Medicine and Rehabilitation specialists) focus on comprehensive, non-surgical management. These specialists often use advanced diagnostic tools like specialized ultrasound to visualize tendon damage. They are skilled in performing advanced injection therapies, which may include Platelet-Rich Plasma (PRP) injections or dry needling, aimed at stimulating the body’s natural healing processes. Their focus is on developing a detailed treatment plan that corrects movement patterns and prevents recurrence without the need for an operation.
The Role of Rehabilitation Professionals
Rehabilitation professionals are essential for long-term recovery and are often involved in the treatment plan even before seeing a specialist.
Physical Therapists (PTs)
Physical Therapists (PTs) concentrate on restoring strength, mobility, and overall function of the elbow and arm. Their treatment includes manual therapy techniques, such as soft tissue mobilization, and specific strengthening exercises, particularly eccentric training, which helps remodel the injured tendon tissue. The PT’s goal is to ensure the arm can withstand the physical demands of everyday life and sport without reinjury.
Occupational Therapists (OTs)
Occupational Therapists (OTs) focus specifically on a patient’s ability to perform daily activities and modify the environment to reduce strain on the tendon. They assess and adjust the way a patient performs tasks like gripping, typing, or lifting, often recommending ergonomic changes to tools, workspace, or technique. OTs may also create custom splints or recommend adaptive equipment to protect the tendon while it heals, ensuring that the habits that led to the injury are corrected to prevent its return.