|3475 Torrance Blvd., Ste F
Torrance, CA 90503
Office hours: M-F, 9am
– 5 pm
Worker’s compensation, Medicare
and most insurance plans accepted.
In September 2008, we will be moving to a beautiful new 4,400 sq ft,
state of the art dedicated hand center located at 2808 Columbia Ave
in Torrance, CA., which will feature onsite nerve conduction studies,
occupational hand therapy and digital x-ray.
Tennis elbow or “lateral epicondylitis” was initially described
in 1882 as a common lawn tennis injury that arose due to the backhand
stroke. It was initially believed that the pain was due to inflammation
caused by a partial tear of the tendon of one of the major wrist extensors
where it attached to the bony prominence on the outer aspect of the elbow
i.e. the lateral epicondyle. It is now thought the pain is due to an inadequate
repair process of this tear rather than acute inflammation. This may be
due to relative lack of blood supply to the undersurface of this tendon
which impairs its ability to heal.
It occurs equally in men and women, usually between the ages 35 and 50.
Typically one will complain of pain over the lateral aspect of the elbow
that is worsened by lifting or gripping but even simple activities such
as brushing the teeth or picking up a coffee cup can cause considerable
discomfort. Point tenderness over the lateral epicondyle is present which
is exacerbated by resisted wrist and finger extension. Patients with radial
tunnel syndrome often have coexisting lateral epicondylitis and require
careful examination to determine if one or both diagnoses apply. X-rays
are usually normal although calcification along the lateral epicondyle
may be seen.
The hallmark of treatment is activity modification, with avoidance of
activities requiring prolonged gripping, such as holding a hand bag, or
activities requiring repetitive grasping or torquing such as using a hammer
or screwdriver. Patient are counseled to lift with their palms up, which
uses the forearm flexor muscles and spares the extensors. A tennis elbow
splint can be worn over the upper forearm, which works by limiting the
muscle excursion of the extensor muscles. A wrist splint may help by holding
the wrist in extension which puts the forearm wrist extensor muscles at
Therapy can be of use and includes ultrasound, iontophoresis, massage,
stretching and gradual strengthening exercises. The most commonly injected
substance is a combination of local anesthetic and corticosteroid. Up
to three injections at least 6 weeks apart can be beneficial. Multiple
injections however should be avoided since tendon rupture can occur. The
risks of corticosteroid injections include skin atrophy and discoloration.
Other substances injected into the lateral epicondyle include autologous
blood, botulinum toxin (Botox) and glycosaminoglycans with varying success
rates. Acupuncture has been shown to provide short-term pain relief. Extracorporeal
shock wave therapy (ESWT) has been tried as a nonoperative but recent
reports have shown little benefit compared with other treatments, with
morbidity from ESWT including pain, reddening of the skin, hematoma, and
Surgery is recommended only after a patient fails conservative treatment,
which includes activity modification, splinting, therapy, and injection.
Multiple surgical techniques have been described for this problem.
The majority of lateral epicondylitis surgeries involve some type of release
or lengthening of the extensor carpi radialis brevis tendon, which is
one of the major wrist extensor muscles. Most of the recent studies of
ECRB release or lengthening have shown a 69% to 100% success rate with
decreased pain and improved function
Debridement of the Extensor Origin (link to video)
In 1979, Nirschl and Pettrone described incising and retracting the ECRL
to reveal the ECRB tendon origin, which was incised with debridement of
fibrous or granulation tissue, removal of necrotic-appearing ECRB origin,
inspection of the lateral aspect of the joint, and excision of a small
amount of bone over the lateral epicondyle. In 88 patients treated for
chronic lateral epicondylitis, 97.7% showed improvement over their preoperative
status and 85.2% were able to return to work, having achieved complete
pain relief by 3 months. Later studies showed 83% to 94% pain relief in
patients treated with ECRB release and debridement.
Most people can perform one-handed work activity by the 2nd week followed by light duty including clerical work at 6-8 weeks. Heavy manual labor can often be resumed by 12 - 16 weeks but recurrences with repetitive gripping activities are common hence gripping restrictions may be necessary..