As the lovely folks of Wisconsin start to welcome Spring and get back to their recreational activities, aches and pains start to arise. One of those aches and pains occurs in the elbow and is formally called Epicondylitis. The pain associated with this over-use injury can hinder one’s ability to take advantage of our coveted warm weather days.
Epicondylitis is inflammation in the region of the epicondyles (bony prominences) in the elbow. The muscles in the forearm attach to these epicondyles via tendons that become irritated or inflamed due to overuse or repetitive motion. If the wrist extensor muscles that attach to the lateral side of the elbow are irritated, it is called Lateral Epicondylitis or “Tennis Elbow.” Alternatively, if the wrist flexor muscles that attach to the medial side of the elbow are irritated, it is called Medial Epicondylitis or “Golfer’s Elbow.” These pathologies are aptly named after the activities that are likely to cause discomfort.
People who are struggling with Lateral Epicondylitis often report pain localized to the lateral epicondyle, pain with gripping, pain with any extension of the wrist, pain when picking up objects palm-down, pain with activities like hammering, tennis, pickleball, and (believe it or not) talking on the phone. People who are plagued by Medial Epicondylitis report more pain around the medial epicondyle on the inside aspect of the elbow, pain with flexing of the wrist, discomfort when holding objects palm-up, and pain with activities such as golf. Nighttime pain as well as pain radiating into the forearm is common regardless of which side of the elbow is aggravated. Unfortunately, it is possible for someone to be dealing with epicondylitis on both sides of the elbow simultaneously.
Epicondylitis is considered a self-limiting condition. You cannot cause further structural damage by continuing with activity despite your discomfort. The symptoms typically ebb and flow and will eventually resolve on their own, though this could take months or even years. The interventions to help alleviate symptoms are typically conservative rather than surgical: home exercises or formal physical therapy, oral and topical anti-inflammatory medication, avoidance of aggravating activity, nocturnal wrist bracing, and use of a counterforce strap at the elbow. Current research demonstrates that cortisone injections actually cause symptoms to persist and even worsen over time, so they are not typically recommended.
Ultimately, if symptoms persist despite these conservative measures, a small procedure could be performed called a Tenex Procedure. Under local anesthetic, the doctor will use ultrasound guidance to percutaneously remove the damaged fibers and probe the tendon to stimulate healing. Though down time following this procedure is minimal, it does not improve symptoms overnight. Typically, patients notice improvement in their symptoms over 2-3 months following the procedure.