Many people with mild tennis elbow symptoms can relieve their pain by resting the arm and taking over-the-counter painkillers. They can also try special stretching and strengthening exercises, or change the way they do activities that put strain on the arm. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or paracetamol, can ease mild pain and inflammation but should not be used long-term because of the risk of stomach problems.
Corticosteroid Injections
A cortisone injection into the painful area of your elbow (lateral epicondylitis) can help decrease inflammation and pain for a few weeks. This may be enough to allow you to resume your usual activities and prevent the condition from recurring. However, the injection itself does not cure tennis elbow. Unless you modify the way you use your arm and wrist, the symptoms will likely return. For more information, visit this website at https://saunders-therapy.com/.
Your doctor may perform a physical examination of the affected area and order imaging tests, such as an MRI or an ultrasound, to confirm the diagnosis. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can ease mild pain and swelling. These can be taken as pills or applied as gels or creams.
A physical therapist can help you stretch and strengthen the affected muscles and recommend ways to change your work or leisure activities to prevent overuse of your wrist and arm. This may include using a splint or wrap to decrease stress on the injured tendons. Acupuncture can also help with pain.
If your pain continues to persist, your doctor may inject the affected tendon with a steroid. The most common steroid used for this purpose is a corticosteroid, which can reduce inflammation and pain. This injection is usually given with an anesthetic and guided by ultrasound imaging. A number of studies have compared the effectiveness of different injections and of a placebo (a saline injection) for tennis elbow. However, none of these studies showed that any injection was superior to a saline injection.
Although a cortisone shot can temporarily reduce the pain of inflammation, it cannot heal a tendon at the cellular level. In fact, there is evidence that a cortisone shot actually inhibits the growth of healthy tendon cells.
A newer treatment, called platelet-rich plasma (PRP), involves drawing a blood sample from your arm and then spinning it to separate the platelets. These contain many healing proteins and other substances. Your doctor then uses this blood to inject into the affected area of your elbow. Some studies have shown that PRP can be effective in treating refractory tennis elbow and other musculoskeletal injuries.
Platelet-Rich Plasma Injections
The elbow joint is held together by three bones: the upper arm bone (humerus) and two bones in the forearm (radius and ulna). The outside of the elbow has a bony bump called the lateral epicondyle, where several muscles of the forearm start their course. Tennis elbow is caused by an irritation of the tendons attached to the lateral epicondyle, which results in chronic tendinitis. Symptoms include pain on the outside of the elbow and often also on the back of the hand.
Usually the condition is treated with self-help techniques and over-the-counter painkillers, although your GP may refer you to a physiotherapist. The physiotherapist can teach you how to modify the way you move your wrist and arm to reduce the strain on the tendons, which will help with your symptoms. They can also recommend exercises to strengthen the muscles around the painful area.
Another treatment option for tennis elbow is platelet-rich plasma injections. This involves taking a sample of blood from the patient, then spinning it in a centrifuge to separate out the platelets. These are then injected into the painful area of the elbow under ultrasound guidance. It is a relatively new technique, but early studies indicate that it can provide significant pain relief for patients with tennis elbow.
The injections contain healing proteins, including growth factors, which can stimulate the body’s natural repair processes to heal the tendons. The procedure is performed under local anaesthesia. It is not a quick fix, and will take some time before you will see any benefits. But the good news is that it is believed to be a safe and effective treatment, as it is using your own blood so there is less risk of a reaction. The injections can be repeated as necessary, with the research suggesting that they work better the more times they are used. The only downside of this treatment is that it is very expensive compared with the other treatments, and may not be covered by insurance. However, it could be worth it if your other options do not give you any benefit or do not help you for several months.
Ultrasound Tenotomy
If you have persistent elbow pain after six to 12 months of nonsurgical treatments, your doctor may recommend a surgical procedure called tenotomy. This involves cutting away damaged tissue in the affected tendon to relieve your pain and improve the function of the tendon. This surgery can be performed through a large incision or several small ones, depending on your situation.
An ultrasound tenotomy is a less invasive option for treating tennis elbow. In this procedure, your provider inserts a needle through the skin into your affected tendon and then uses ultrasound to guide the needle. The ultrasound waves vibrate the needle, causing it to cut into the affected area of your tendon and liquefy the damaged tissue. This is then suctioned out of your body.
Percutaneous ultrasound guided tenotomy is a simple procedure that can be done in your provider’s office. Your provider will use a local anesthetic to numb the area around your injured tendon. They will then use a special needle to poke into the tendon and either break up or remove any damaged parts of the tendon. The needle is removed and your provider will then apply a bandage to the area.
The pain from this procedure will usually go away within a few days. Your doctor will typically recommend that you work with a physical therapist after this procedure to help your arm heal and teach you techniques to prevent future injuries. They can help you do range of motion and strength training exercises that will encourage the healing process.
Some patients who have a tenotomy experience symptoms returning, especially if they continue to overuse their injured tendons. This can happen if they repeat a specific motion for their job or as part of an activity or sport. If this happens, your doctor may recommend that you have another tenotomy procedure or a different type of surgical procedure.
Tenotomy can treat lots of issues with tendons throughout your body. It’s used after injuries and to fix health conditions that damage tendons. These procedures are safe, quick, and effective at relieving your pain and improving the condition of your tendons.
Surgery
Many adults get tennis elbow or golfer’s elbow, a condition that develops when tendons repeatedly strain. They may develop microtears that lead to inflammation and pain where they attach to bone. These symptoms often happen when lifting or bending the wrist (like opening a jar or gripping something).
People with tennis elbow can find relief with rest, pain medicines and physical therapy. But they may need a procedure or surgery if those treatments don’t help or their pain gets in the way of daily activities.
Doctors diagnose this condition by asking about the person’s past health and doing a physical exam of the elbow and wrist. They may also use a pressure sensor to measure the force of the pain and an imaging test to check for damage.
Treatments for this condition include over-the-counter pain relievers, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), as well as heat or cold packs to reduce swelling. Doctors may recommend a splint or brace that wraps around the elbow to take pressure off the tendon. They may also inject corticosteroid medicine to decrease inflammation. In some cases, doctors use ultrasound to break up scar tissue and encourage healing.
A study published in the journal “Physicology” in February 2018 found that people with persistent tennis elbow who underwent an MRI and a platelet-rich plasma injection experienced the best recovery, including the least amount of pain. Platelet-rich plasma is a type of blood that contains healing platelets, which can be separated from the sampled blood. Doctors can then inject the mixture into the affected area.
Several studies have shown that a combination of rest, physical therapy and the injections can improve the condition in about half of patients with persistent pain. But the injections are not widely available in doctors’ offices, and they can cost $500 or more.
For most people with this condition, surgery is a last resort. They might have a surgical procedure called lateral epicondyle release surgery, which involves removing the damaged part of the tendon and reattaching it to the bone. This operation usually takes place in an outpatient facility, and the person can return to most activities within a few weeks.
