How is Tennis Elbow treated?
The majority of cases of tennis elbow get better without surgery. Your doctor will examine your elbow and perhaps take X-rays to evaluate the bones and joints of the elbow. If the problem is determined to be lateral epicondylitis, then treatment consists of the following (all techniques may not be necessary at once):
1. Modification of Activity:
General activities which make the pain worse should be avoided or at least cut back. For tennis players this may mean playing less tennis. Alternatively, modifying the stroke or the grip size on the racquet may help. Use of the arm and hand within the limits of pain is recommended. In general, the patient can do anything that doesn't hurt. While continued activity in the presence of mild discomfort is not harmful, severe pain will only prolong the necessary recovery time and should be avoided.
Cold therapy is very helpful for this condition to limit pain and to decrease inflammation. It is recommended that the area be iced 2 to 3 times a day, especially after any activity such as sports or work. Ice can be applied with an ice bag or the area can be rubbed or massaged with an ice cube (ice massage). The ice should be applied for 20 to 30 minutes each time.
Oral nonsteroidal anti-inflammatory drugs are very helpful in controlling the pain and inflammation of tennis elbow. These medications are aspirin-like medicines which include ibuprofen (Motrin, Advil, Nuprin, Medipren, etc.), and other prescription medications (Naprosyn, Indocin, Feldene, Relafen, etc.). We recommend the medicine be taken daily for at least four to six weeks when treating severe cases. For less severe cases these medicines may be taken only when needed. All of these medications can have side effects and should be used under the direction of a physician.
4. Stretching and Strengthening Exercises
Stretching and strengthening of the involved muscle and tendon unit is one of the mainstays of treatment for this condition. A gentle stretching program is started through a range of motion at the elbow and wrist. This is combined with a program of muscle strengthening. A simple home program can be demonstrated by your physician in the office. In more severe cases, a referral to a physical therapist can be made for a supervised program.
Tennis elbow straps are found to be helpful by some patients. There are several different models available and they are designed to be worn 2-3 centimeters from the elbow.
This is intended to take the stress off the tendon where it attaches to the bone. The strap is to be worn during sports and during work. These straps should not be used as a sole means of treatment, but should supplement muscular stretching and strengthening exercises.
6. Wrist braces
These are worn on the wrist to keep the wrist bent backwards, taking the stress off of the muscles as they attach at the elbow. Although not utilized routinely, some physicians utilize them when the pain is severe and when other measures have failed. They are primarily to be used at night while sleeping but they can be used during the day as well.
7. Cortisone shots
These are considered when the measures above have not worked and the pain is severe. The cortisone is injected into the area of the inflamed tendons in order to decrease the inflammation. After the shot, most physicians recommend that the patient return to using ice and anti-inflammatory medication. Sometimes the shot is curative and sometimes more than one shot is necessary.