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The F.A.S.T. Cure for Tennis Elbow (Lateral Epicondylitis)
Posted on July 13, 2016

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Tennis elbow, or lateral epicondylitis , is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. But several other sports and activities can also put you at risk.
Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.
There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists, and, in some cases, surgeons work together to provide the most effective care.
Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.
Muscles, ligaments, and tendons hold the elbow joint together.
Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).
Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.
The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.
Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle.
Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.
Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.
Lateral epicondylitis can occur without any recognized repetitive injury. This occurence is called “insidious” or of an unknown cause.
The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.
The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however both arms can be affected.
Your doctor may recommend additional tests to rule out other causes of your problem.
These may be taken to rule out arthritis of the elbow.
Using an in-office ultrasound machine, your doctor can quickly diagnosis tennis elbow.
If your doctor thinks your symptoms are related to a neck problem, an MRI scan may be ordered. This will help your doctor see if you have a possible herniated disk or arthritis in your neck. Both of these conditions often produce arm pain.
Your doctor may order an EMG to rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.
Approximately 80% to 95% of patients have success with nonsurgical treatment.
Rest. The first step toward recovery is to give your arm proper rest. This means that you will have to stop participation in sports or heavy work activities for several weeks.
Non-steroidal anti-inflammatory medicines. Drugs like aspirin or ibuprofen reduce pain and swelling.
Equipment check. If you participate in a racquet sport, your doctor may encourage you to have your equipment checked for proper fit. Stiffer racquets and looser-strung racquets often can reduce the stress on the forearm, which means that the forearm muscles do not have to work as hard. If you use an oversized racquet, changing to a smaller head may help prevent symptoms from recurring.
Physical therapy. Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.
Brace. Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons.
If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your doctor may recommend surgery.
Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone.
The right surgical approach for you will depend on a range of factors. These include the scope of your injury, your general health, and your personal needs. Talk with your doctor about the options. Discuss the results your doctor has had, and any risks associated with each procedure.
F.A.S.T. Procedure. The innovative FAST procedure—Focused Aspiration of Scar Tissue—is based on advanced technology developed in collaboration with the Mayo Clinic. FAST is a minimally invasive procedure designed to remove tendon scar tissue quickly and safely, without disturbing your surrounding healthy tendon tissue.
Click here to watch the F.A.S.T procedure.
Arthroscopic surgery. Tennis elbow can also be repaired using tiny instruments and small incisions. Like open surgery, this is a same-day or outpatient procedure.
Surgical risks. As with any surgery, there are risks with tennis elbow surgery. The most common things to consider include:
Rehabilitation. Following surgery, your arm may be immobilized temporarily with a splint. About 1 week later, the sutures and splint are removed.
After the splint is removed, exercises are started to stretch the elbow and restore flexibility. Light, gradual strengthening exercises are started about 2 months after surgery.
Your doctor will tell you when you can return to athletic activity. This is usually 4 to 6 months after surgery. Tennis elbow surgery is considered successful in 80% to 90% of patients. However, it is not uncommon to see a loss of strength.

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Lateral Epicondylitis (Tennis Elbow)

Pain or tenderness on the outer side of the elbow.
Pain when the wrist or hand is straightened.
Pain worsened by lifting a heavy object.
Pain with making a fist, gripping an object, shaking hands or turning door handles.

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The elbow joint is made up of the bone in the upper arm (the humerus) and one of the bones in the lower arm (ulna). The bony prominences, or bumps, at the bottom of the humerus are called the epicondyles. The bump on the outer side of the elbow is called the lateral epicondyle.
Lateral epicondylitis is a condition that causes pain and tenderness at the prominence on the outer part of the elbow. The condition occurs as a result of overusing the forearm muscles that straighten and raise the hand and wrist. When tendinopathy, or fiber microtearing, occurs at the muscle origins at their point of attachment, the lateral epicondyle. Small tears in the tendon tissue can occur, and the muscles may strain and irritate their attachment at the bone. These muscles act to extend the wrist and allow lifting.
Despite the common name for lateral epicondylitis, tennis elbow, the condition can be caused by other activities besides playing racquet sports. Many commonplace activities can strain the tendons. Basically, any activity that twists and extends the wrist can lead to lateral epicondylitis. Rarely, a direct blow to the outside of the elbow can also lead to the condition.
Non-Operative
The first step in treating lateral epicondylitis is to eliminate the activities that cause or make your symptoms worse. Activity modification should be attempted for at least six weeks to see if symptoms improve. Tennis elbow is thought to be self-limited, meaning that it often resolves on its own, given time. This has been supported by studies showing improvement over time.
Your health care provider may prescribe an anti-inflammatory medication to decrease pain. Injections of steroid (cortisone), blood, or platelet-rich plasma (PRP) directly into the area may also be an option. Treating the area with an ice pack, performing an ice massage, and stretching are also recommended. A tennis elbow strap, or counterforce brace, may be worn just below the elbow to provide support to this area. If these methods do not help, your health care provider may also send you for a course of therapy. Your therapist will instruct you on exercises designed to strengthen the forearm muscles.
Operative
If the condition does not respond to the above treatments for an extended time period, surgery may be necessary. The surgery is usually performed on an outpatient basis. An incision is made on the outside of the elbow, and the surgeon will explore the tendons and may remove tissue that has degenerated. He or she may have to cut the tendon at its attachment to the bone, and remove a small portion of the bone to improve the blood supply to the area.

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