Lateral epicondylitis, commonly known as tennis elbow, involves the inflammation or degeneration of the tendons connecting the forearm muscles to the outside of the elbow. This injury is caused by the repetitive overuse of these muscles, leading to pain and tenderness. Navigating care involves a sequence of medical professionals, starting with general care and progressing toward specialized interventions.
Initial Consultation: Primary Care and General Practitioners
The first medical professional consulted for elbow pain is typically a Primary Care Physician (PCP) or General Practitioner (GP). These doctors serve as the initial point of contact for diagnosis and conservative treatment. They perform a physical examination to assess the range of motion and pinpoint the tender area on the lateral epicondyle, the bony prominence on the outside of the elbow.
The primary role of the PCP is to confirm the diagnosis of tennis elbow while ruling out other possibilities, such as nerve compression or arthritis, sometimes using imaging. They prescribe initial, non-invasive treatments, including rest, applying ice, and using over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). If symptoms persist after several weeks, the PCP refers the patient to a specialist for more targeted care.
Specialized Non-Surgical Treatment: Sports Medicine and Physiatry
When initial conservative measures fail, patients are referred to specialists focused on non-operative musculoskeletal care, primarily Sports Medicine Physicians and Physiatrists. Sports Medicine Physicians specialize in injuries from repetitive strain, offering advanced treatment strategies. Physiatrists (Physical Medicine and Rehabilitation specialists) focus on restoring function and managing pain without surgery, often coordinating rehabilitation plans.
These specialists manage non-surgical interventions aimed at promoting healing and reducing chronic pain. A common treatment is the corticosteroid injection, which delivers anti-inflammatory medication directly into the painful area for short-term relief. However, the effects are often temporary, and long-term use can potentially weaken tendon tissue.
For more sustained healing, specialists may recommend regenerative therapies like Platelet-Rich Plasma (PRP) injections. PRP involves isolating a concentration of a patient’s own platelets, which contain growth factors, and injecting them into the damaged tendon to stimulate tissue repair. While corticosteroids may provide faster short-term improvement, PRP often yields superior, more sustained outcomes for pain and function. Other advanced non-surgical options managed by these doctors include dry needling or extracorporeal shock wave therapy (ESWT).
A significant component of treatment is directed rehabilitation, which is overseen by these physicians and carried out by physical or occupational therapists. Physical therapy focuses on stretching and strengthening the forearm muscles, often utilizing eccentric exercises. Occupational therapists help patients modify the tools, grip, or techniques used in their work or sport to prevent re-injury and reduce strain on the recovering tendon.
When Surgery is Necessary: The Role of the Orthopedic Surgeon
Surgery is typically reserved for cases (less than 10%) where tennis elbow does not respond to specialized conservative treatment after six to twelve months. The patient is then referred to an Orthopedic Surgeon, who specializes in surgical procedures for the musculoskeletal system. The surgeon evaluates the structural damage and determines if an operative procedure is warranted.
Surgical goals are to remove damaged tendon tissue and restore healthy attachment to the bone. Procedures include open surgery (a single incision to visualize and repair the tendon) or arthroscopic surgery (using small incisions and a camera). Both methods typically involve debridement, the removal of unhealthy tissue.
Following surgery, the orthopedic surgeon manages post-operative recovery, including immobilization followed by a structured rehabilitation program. Although surgery is a last resort, it is highly effective, with success rates often reported between 85% and 90% in improving function and reducing chronic pain.