What is Tennis Elbow? Causes, Symptoms and Treatment : Q&A with Dr. Michael Shepard

Less than 5% of all tennis elbow diagnoses are related to actually playing tennis. We recently spoke with Dr. Michael Shepard, a board certified orthopedic surgeon at HOI with specialty in sports medicine and overhead athletes who filled us in on this common injury.

Question: What is Tennis Elbow?

Answer: Tennis elbow is also known as lateral epicondylitis, but it would be more aptly described at lateral tendonosis. Tendon degeneration is referred to as a tendonosis. Tennis elbow is a degeneration of the common extensor tendon attachment at the elbow. The common extensor tendons are used in power grip and wrist extension.

Question: What type of injury is it? What muscles/tendons are affected?

Answer: The tendonosis or degeneration involves the common extensor origin, which is a collection of muscles that perform wrist extension and used in grip. The muscle that typically degenerates and or tears most commonly is the ECRB (extensor carpi radialis brevis). Surgery often involves repair of the ECRB attachment to the humerus at the lateral epicondyle.

Question: What are the symptoms

Answer: The most common symptom is pain with grip on the lateral or outside of the elbow. Often patients will complain about pain with even the smallest tasks - picking up a coffee cup, carrying groceries, or shaking hands. Obviously, gripping sports are particularly painful - golf, tennis, weight lifting, etc. If the tendon goes on to tear significantly then the patient may experience weakness.

Question: Does it only affect tennis players? What are some other contributors to this type of injury?

Answer: Tennis elbow can affect all types of people - not just athletes. The most common contributor to tennis elbow is repetitive gripping or grasping. Commonly, people who use their hands in manual labor or for gripping sports such as weightlifting, racquet sports, or archery are most likely to have tennis elbow symptoms. Another common contributor to tennis elbow is poor posture or a poorly set up work station. When the shoulder is in a poor protracted position it puts increased stress on the lateral elbow and leads to increased rates of tennis elbow.

Question: How has it been treated in the recent past? In worst case scenarios, are their surgical interventions that are taken?

Answer:In the past, tennis elbow was treated with multiple steroid injections and surgical releases. Unfortunately, repeated steroid injections can lead to increased degeneration of the tendons and therefore increased tearing of the common extensor tendons. Presently, treatment focuses on removing irritating factors such as non-ergonomic work stations, repetitive gripping activities, or carrying heavy loads. Physical therapy can be helpful by focusing on the elbow, shoulder, and postural training. Recently, platelet rich plasma (PRP) has been used in injections to the diseased tendon. PRP contains the healing and growth factors that are circulating through your blood. The PRP from your own blood is injected under ultrasound guidance into the diseased portion of the tendon in an attempt to get it to heal. Finally, if all else fails then surgery is a successful treatment option. Surgery involves debridement of the damaged or dead tendon and then reattachment of the diseased tendon to the humerus. If needed, these modern surgical techniques can obtain up to 95% success rates in relieving patients' pain.

Question: What are the most current preventive treatments? Anything else you think people should know about this injury?

Answer: The key to prevention is avoiding over use activities whether these be at work or in leisure activities. A work station that is ergonomically designed can be helpful. A regular work station stretch program can be performed on a hourly basis for people with desk type jobs. Focus on core and posture training can help with the athlete to prevent tennis elbow. Tennis elbow can be thought of as an overuse injury to the tendons. Like any overuse injury, moderation and cross training can help the athlete prevent against overuse injuries such as these.

For more information on Dr. Shepard, click here.