Introduction
Tennis elbow, medically known as lateral epicondylitis, is a relatively common pain condition. According to U.S. statistics, about 1% of the population develops it each year, with incidence rates as high as 40% among tennis players or individuals whose work involves repetitive upper-limb labor. Among affected patients, approximately 5% require sick leave.
Patients typically experience pain on the outer side of the elbow, which impairs upper-limb function; for example, wringing a towel or performing wrist-extension movements can provoke pain.
Causes
Historically, the medical community believed tennis elbow was caused by inflammation, but substantial evidence now indicates it is primarily a degenerative condition resulting from chronic overuse, with inflammation not being the core issue. During normal daily activities or sports, repetitive microtrauma occurs to the tendons of the forearm and wrist muscles. While the body usually heals naturally, the relatively poor blood supply to the tendon area can impede healing, leading to chronic strain and ultimately tennis elbow.
Treatment
Treatment approaches fall into three broad categories: conservative management, physical therapy, interventional procedures, and surgery.
Conservative management includes rest, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and muscle-strengthening exercises; patients may also use a counterforce brace on the forearm to reduce pain. With conservative treatment, about 90% of patients recover within one year.
If conservative measures fail or pain is severe, more aggressive options such as injections or surgery may be considered. Surgery is generally reserved as a last resort, whereas injections are more commonly performed.
During injection therapy, some physicians use ultrasound guidance to improve accuracy and enhance efficacy. Three agents are commonly injected: corticosteroids, botulinum toxin, and platelet-rich plasma (PRP).
- Corticosteroids have traditionally been widely used because tennis elbow was once thought to be inflammatory; steroids were employed to reduce inflammation. Steroid injections are often effective, but the relief may not be durable in many cases. Some experts argue this is because steroids address symptoms rather than the underlying cause, and others suggest that by dampening the body’s intrinsic healing capacity, steroids could potentially worsen the condition long term.
- Given that recent research characterizes tennis elbow as degenerative rather than inflammatory, platelet-rich plasma (PRP) injections have gained traction. In this approach, blood is drawn from the patient, processed to concentrate platelets, and the PRP is injected into the affected area. The rationale is that platelets contain growth factors that can promote repair of degenerated tissue. Although relatively new, an increasing body of medical evidence supports its effectiveness.
- Another option is injecting botulinum toxin into the affected muscle. Botulinum toxin works by temporarily paralyzing the muscle to allow it to rest. Evidence shows it can effectively control pain, though it may occasionally weaken forearm and wrist strength.
Tennis elbow is fundamentally a degenerative rather than an inflammatory problem. Most patients recover with conservative treatment; for refractory or severe cases, injection therapies can be considered.
Information provided by Dr Lee Yuk Ming, Sunny, Specialist in Pain Medicine
Published in Happy Monthly, November issue
