Treatment for Tennis Elbow in Nebraska

Symptoms

Identifying tennis elbow is made easier by the presence of acute tenderness at the most prominent point on the outer elbow. Patients often report a wider area of dull ache on the outer elbow, which may extend to the wrist or radiate upwards towards the shoulder.

The pain of tennis elbow intensifies when reaching for objects with a straight elbow and palm facing downwards. It is not surprising that limiting such actions can alleviate the symptoms.

Diagnosis

Patients with radial tunnel syndrome typically feel more tenderness when the outer part of the elbow bone or the extensor muscle closer to the hand is pressed. If there is no pain in the outer elbow while resisting the upward turning of the forearm either with an extended or flexed elbow, it can rule out the possibility of radial tunnel syndrome.

While X-rays are usually normal, more advanced imaging techniques such as a CAT scan or MRI are not typically necessary. It is important that tennis elbow pain is not misdiagnosed as related to fibromyalgia, which is a common error that can delay appropriate tennis elbow therapies.

Cause

The principal contributing factor to tennis elbow is the age-associated degeneration of the extensor tendon. Although an element of "overuse" is often detected, it’s not always the case. Interestingly, a significant number of patients suffering from this condition are retirees or individuals leading a sedentary lifestyle.

Our rigorous evaluation of surgical tissue specimens from impacted elbows reveals a lack of inflammation but clear evidence of tissue degeneration. Thus, the terminology "itis", which denotes inflammation, is misleading; epicondylalgia, indicative of pain in the elbow region, is the accurate term. 

It's also worth noting that patients with carpal or cubital tunnel syndrome often concurrently develop tennis elbow, largely due to the innervation of the outer elbow by the radial nerve, independent of the nerves implicated in the tunnel syndromes. 

Comorbidities (Other conditions occurring at the same time)

Individuals receiving treatment for carpal or cubital tunnel syndrome often struggle with tennis elbow as a coinciding condition. Imperfect functioning of the radial nerve, which innervates the outer elbow, is suspected to play a significant role in the onset of symptoms, hinting at the possibility of a peripheral neuropathy.

At least two prominent surgeons, Emmanuel Kaplan in the 1950's and Wittenberg in the 1980's and Dellon in the 2000's have promulgated denervation of the outer elbow as a solution. This has led to a solution providing the least invasive, fastest recovery, and lowest cost.

Tennis Elbow Treatment Options

Non-Surgical Approaches

At Nebraska Hand and Shoulder Institute, we know that tennis elbow pain can persist for several months before it starts to improve or becomes tolerable. There's a wide range of views on the most effective treatment for tennis elbow. While physical therapists may offer help, our experience shows that increased activity often exacerbates the symptoms, and physical therapy does not always provide enduring relief.

One option for tennis elbow relief is cortisone injection. Though there's no definitive scientific explanation for why it should work, many patients report relief that lasts for several weeks, months, or even becomes permanent. This treatment usually involves a minimal risk, just a day or two of increased pain following the injection. Wearing a snug wrap or tennis elbow strap can also offer some relief, although it does not provide a cure for tennis elbow.

Surgical Interventions

Dr. Ichtertz, our experienced tennis elbow surgeon, offers several surgical options for severe cases of tennis elbow. However, percutaneous lateral elbow tenotomy is generally considered the most logical choice. It's widely recognized for its success rates in tennis elbow treatment. This method, reported by various surgeons since 1980, is cost-effective, leaves no visible scar, doesn't necessitate time off work, and involves minimal risk.

The healing process is fairly swift, usually reaching maximal medical improvement within three to four months. The other surgical options, such as Extensor Origin Debridement (Nirschl procedure), arthroscopic extensor origin debridement, and Tenex (an expensive, still investigational cautery technique), carry more risk and come with a longer recovery period. Notably, the Nirschl procedure leaves a substantial scar, which may not be ideal for many patients.

Results

Results of tennis elbow treatment can vary based on age, occupation, habits and overall health state. Our non-operative care and operative techniques have shown impressive results. In fact, up to 90% of patients who undergo percutaneous tenotomy - a minimally invasive procedure - experience good to excellent outcomes. Within three months, around 70% of these patients are pain-free, with another 20% achieving Maximum Medical Improvement (MMI) shortly thereafter. 

For those suffering from tennis elbow pain, returning to work is a crucial part of recovery. Most of our patients, particularly those with worker's comp cases, can resume work with minor restrictions almost immediately after treatment.

Despite innovative surgical techniques, some procedures, like the arthroscopic ECRB debridement, may not provide optimal outcomes. This expensive procedure often places nerves at risk and has been noted to produce less satisfactory results.

An alternative procedure, open lateral epicondylectomy, though effective in relieving tennis elbow pain, can be discomforting and require extensive healing time. This treatment could also leave visible scars and elevate expenses due to time off from work.

Factors Affecting Outcome

Workers comp patients in my practice recover more slowly but ultimately do quite well; it's just harder to get the average person blaming his job for a problem and at odds with his employer to concede recovery. This is especially true if the injured worker has no job to go back to or hates the position. Self abuse with smoking and/or heavy alcohol consumption can also not be expected to benefit healing.

Schedule Your Appointment Today

At Nebraska Hand and Shoulder Institute, our mission is to offer tennis elbow relief and implement effective tennis elbow treatments. Our team has years of experience in the medical field, and our goal is to provide top-notch care for individuals suffering from this common condition.