Joseph Yao, M.D.

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Tennis elbow

Pain on the outside (lateral) of the elbow is a common problem, and it is often due to lateral epicondylitis, also known as tennis elbow. It can be caused by repetitive use of the arm for activities such as throwing chains over a load on a trailer or using the steering wheel or gear shifter. It can also be due to a single, abruptly applied force, such as pulling a rope.
     People with tennis elbow experience pain over or near the bony prominence located on the outside (lateral side) of their elbow. This hard prominence, called the lateral epicondyle, sticks out above the rest of the bone, so it is generally easy to find by pressing around the outside of the elbow. The lateral epicondyle is part of the lower end of the humerus (the bone that goes between the shoulder and elbow) and it serves as the attachment site for the muscles that run down the forearm to the wrist and hand. These muscles extend (raise upwards) the wrist and fingers.
     Tennis elbow pain is usually worse when the elbow is extended (straightened out). Lifting and gripping aggravates the lateral elbow pain. The pain can sometimes radiate into the muscles of the upper forearm, called the extensor wad muscles. There can sometimes be a mild amount of swelling over the lateral epicondyle. There is no associated numbness or local skin discoloration. A positive tennis elbow sign is present when lateral epicondyle pain occurs with resisted wrist extension (raising the wrist upwards against an applied force).
     X-rays will be normal with tennis elbow, but they can help to evaluate other causes of elbow pain such as arthritis or tumor. Treatment includes resting the arm to permit healing. Nonsteroidal anti-inflammatory medications can be used along with stretching and strengthening exercises for the hand and wrist extensor muscles. Physical therapy can sometimes be helpful. A tennis elbow strap wrapped around the upper forearm below the lateral epicondyle helps to reduce pulling of the muscles at their lateral epicondyle attachment site.      Roughly 95 percent of people will heal within four months. Those cases that fail to heal with nonsurgical treatment usually involve a torn or degenerated area, where the hand and wrist extensors (most often the extensor carpi radialis brevis or the short extensor muscle to the thumb side of the wrist) attach to the lateral epicondyle.
     Surgical treatment includes removal of the torn or degenerated area. A thin wafer of bone is excised from the lateral epicondyle creating a raw, bony bed over which the adjacent normal tissue is sewn. A rigid plaster splint immobilizes the elbow for one week after surgery. The splint is then discarded and a tennis elbow strap is worn for protection for about three months.
     Dr. Joseph Yao has undertaken extensive subspecialty training in joint replacement after completing an orthopedic surgery residency. Dr. Yao has been in private practice orthopedic surgery since 1987, and he has treated many truck drivers for joint and nerve ailments.