Tennis Elbow Treatment, Lateral Epicondylitis

Most people with tennis elbow have never played tennis. The condition affects painters, plumbers, carpenters, cooks, and anyone whose work involves repeated gripping with the wrist extended, and it peaks between thirty five and fifty five in people whose sport is not the cause of it.

Steven Struhl, MD is board certified in orthopedic surgery and holds separate board certification in sports medicine, earned after a sports medicine fellowship at Penn State University, and he has served as a medical consultant to the United States Open tennis tournament. He has practiced in New York since 1991. Tennis elbow resolves in the large majority of patients without an operation, and the treatments that work are more specific than rest.

Tennis Elbow Symptoms

• Pain on the Outside of the Elbow: localized to a point over the bony prominence, tender to direct pressure.
• Pain With Gripping: shaking hands, lifting a coffee cup, or turning a doorknob.
• Weak Grip: frequently the symptom that brings patients in, since dropping things is harder to ignore than aching.
• Pain Radiating Into the Forearm: following the extensor muscles down toward the wrist.
• Worse After Activity: rather than during it, which delays recognition.
• Morning Stiffness: in the elbow and forearm.

What Tennis Elbow Actually Is

The name misleads twice. It is not caused by tennis in most patients, and despite the “itis” ending it is not inflammation. What is happening inside the tendon is degeneration of the collagen structure at the common extensor origin, which is why anti inflammatory medication alone tends to disappoint and why the condition takes months rather than weeks to resolve.

• Repetitive Gripping: with the wrist held in extension, the mechanism in nearly all cases.
• Occupational Load: trades and jobs involving tools, sustained gripping, or repeated wrist extension.
• Racquet Sports: particularly a backhand struck with poor mechanics, or a grip size that does not suit the hand.
• Sudden Increase in Load: a weekend of painting or a new gym program.
• Age: tendon quality declining, with peak incidence in the forties and fifties.

How Tennis Elbow Is Diagnosed

The diagnosis is clinical. Point tenderness at the lateral epicondyle, reproduced by resisted wrist extension and by resisted middle finger extension, establishes it in most cases. Examination also checks the ulnar nerve and the joint itself, since cubital tunnel syndrome, radial tunnel syndrome, and early elbow arthritis all produce overlapping symptoms and are treated differently. Radiographs are taken when the pain is atypical or has not responded. MRI or ultrasound is reserved for cases that fail treatment, where the extent of tendon degeneration or a partial tear becomes the question.

Tennis Elbow Treatment

• Load Modification: changing how the arm is used rather than resting it completely, since tendon needs load to remodel.
• Eccentric Strengthening: controlled lowering exercises for the wrist extensors, the treatment with the strongest evidence.
• Stretching: the extensor group, performed daily.
• Counterforce Bracing: a forearm strap below the elbow, which reduces load at the tendon origin and helps many patients during activity.
• Equipment and Ergonomic Changes: grip size, tool handles, and technique.
• Anti Inflammatory Medication: for symptom control in the early phase.
• Corticosteroid Injection: producing short term relief, and worth understanding clearly, since studies consistently show worse outcomes at one year than physical therapy alone.

That last point is worth emphasizing. Injection makes the elbow feel better within days and leaves the tendon in worse condition at a year. It has a role in specific circumstances and it is not the treatment.

Recovery Time and When Surgery Is Considered

Most patients improve over three to six months with a genuine eccentric loading program. Patients who have had symptoms for a year take longer, and patients who stop the program when the pain eases tend to relapse.

Surgery is reserved for the small minority who remain symptomatic after at least six to twelve months of correct non surgical treatment. Dr. Struhl debrides the degenerative tissue at the extensor origin and repairs the healthy tendon back to bone, performed either open or arthroscopically depending on whether there is associated pathology inside the joint. Recovery involves a brief period of protection, progressive strengthening from around six weeks, and return to full activity at three to six months.

Schedule a Tennis Elbow Evaluation in New York City

Elbow pain that has been present for six months and treated with rest and a brace is worth re-examining, both to confirm the diagnosis and to start the loading program that actually remodels the tendon. Dr. Struhl evaluates elbow conditions at his Manhattan and Westchester offices. Contact us to schedule an appointment.