Elbow - Lateral Epicondylitis
Description
Lateral epicondylitis, or tennis elbow, is inflammation of the tendons of the muscles that extend the wrist. The pain is felt where the tendons attach to the bony prominence on the outer aspect of the elbow. This bony prominence is called the lateral epicondyle. Inflammation of these areas is described as epicondylitis.
What are the causes?
Lateral epicondylitis generally occurs as a result of overuse or trauma. Patients that have occupations that require them to repeatedly extend the wrist (carpenters, artists, typists) are at risk for developing lateral epicondylitis. Athletes that play racquet sports are at the highest risk for developing pain on the lateral elbow. When a tendon is overused, microscopic tears occur in the tendon.
What are the symptoms?
Lateral epicondylitis causes pain on the bony prominence on the outer aspect of the elbow. Pain when making a fist or resisted wrist extension is also common and associated with strength loss.
How is it diagnosed?
Dr. Liu will perform a thorough history and physical exam, which typically includes X-rays. Pain over the epicondyle and with resisted wrist extension are hallmarks of lateral epicondylitis. X-rays are typically normal. MRI may be helpful to determine if the pain is from inflammation or a larger tear in the tendon.
Non-operative
Non-operative treatment of lateral epicondylitis is usually the first line of treatment. Your surgeon may recommend anti-inflammatory medicine, physical therapy, activity modification and/or cryotherapy to help reduce the pain and inflammation. An injection may help resolve the symptoms.
Platelet Rich Plasma (PRP) Injections is another non operative option. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. Once injected, the platelets degranulate and release activate growth factors and cytokines to promote healing. A one time leukocyte rich, concentrated PRP injection is recommended. One injection may be all you need, however, there are times where multiple injections may provide additional benefit. Not covered by insurance.
Mesenchymal Stem Cell Injections is another non operative option. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate the stem cells, which are then reinjected into the tendon. The goals are to change the living microenvironment of the tendon, up regulating collagen formation, and promote tendon cell healing and reorganization. Not covered by insurance.
Operative
If non-operative treatment fails to relieve the pain, your surgeon may suggest surgery. In cases where the tendons become detached, surgery is indicated. Your surgeon will make an incision over the injured tendon, remove the injured tissue, and stimulate the area to heal by drilling into, or removing, a section of bone. This allows bone marrow containing blood cells that assist in the healing process to fill the operative site. The tendon is then repaired to the bone with sutures and anchors. Postoperative medication and physical therapy is at your surgeon’s discretion.
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