Doctor’s Tips: Tennis Elbow

Hello USTA Mid-Atlantic Section members, Dr. Brad Carofino here from Atlantic Orthopaedic Specialists in Virginia Beach, VA! Today I wanted to take the opportunity to discuss something that could be all too common for some of you…Tennis Elbow! However, I also want to review treatment options for it that could speed up your recovery and return to play.

Tennis elbow, or Lateral Epicondylitis, in general terms, is a chronic degenerative overuse pathology that causes pain on the outside portion of the elbow. The muscles that extend the wrist, such as in hitting a backhand volley in tennis, can lead to a degenerative weakening or micro-tearing process of the tendon. The tendon becomes necrotic (dying) over extended periods of overuse…just like during long tournament weekends.

This overuse injury can snow-ball if athletes and patients don’t take proper
measures to stop the process and continue to overuse these wrist extensor muscles leading to further tendon injury.

A research article looked at a 13-year period of patient data and determined that the highest incidence of Tennis Elbow was among individuals aged 40 to 49 years, with 7.8 per 1,000 in male patients and 10.2 per 1,000 in female patients. The second highest incidence was from ages 50 to 59 years, with 7.0 per 1,000 in male patients and 6.7 per 1,000 in female patients.¹

Another interesting article noted that in regards to playing tennis, level of play, hours per day, and weight of racquets were directly related to ones’ possibility of acquiring tennis elbow. Also, athletes who were 40+ years of age and older who used a grip size of 4 3/8” or greater had a significantly greater chance of acquiring tennis elbow.²

When athletes or patients come to see me regarding tennis elbow I typically advise them of a few treatment options.

Above most, appropriate rest and recovery is the best thing someone can do as Tennis Elbow is an overuse injury. During a rest and recovery phase it is wise to perform Tennis Elbow stretches, wear a Tennis Elbow strap, and take oral over-the-counter anti-inflammatories for a brief stint.

If things still aren’t improving, I typically suggest seeing a Physical Therapist or Athletic Trainer to perform soft tissue therapies like massage, tool assisted soft tissue mobilization, ultrasound therapy, and even dry-needling.

If things still don’t turn around you could consider a cortisone injection. This option overall is a treatment that will eliminate pain, but is not shown to actually heal what is causing you pain.

If your elbow is still not responding to those treatment options, then some could consider performing surgery to debride the tendon of the necrotic tissue. As you can see, Tennis Elbow can linger for some time without resolution. The treatment algorithm is vast and sometimes cyclical. If you are having trouble with managing acute or chronic overuse Tennis Elbow, please call my Athletic Trainer, Brice Snyder, MSAT, ATC, OTC at 757-679-3407 to schedule an appointment.


Dr. Brad Carofino is an orthopaedic surgeon who specializes in shoulder, elbow and hand injuries. He is a physician with the Atlantic Orthopaedic Specialists in Virginia Beach, Va. AOS provides Athletic Trainers for several USTA Mid-Atlantic Regional, Sectional and other tennis events.

Resources
1. Sanders, T., Maradit Kremers, H., Bryan , A., Ransom, J., Smith, J., & Morrey , B. (2015, July). The Epidemiology and Health Care Burden of Tennis Elbow: A Population-Based Study. Am J Sports Med, 43(5), 1066-1071.

2. H. William Gruchow, P. D. (1979, July 1). An epidemiologic study of tennis elbow: Incidence, recurrence, and effectiveness of prevention strategies . The American Journal of Sports Medicine, 7(4), 234-238