Tennis elbow is a common injury found in tennis players and other sports. The pain is on the outside of the elbow, where the wrist extensor muscles originate, and is usually tender when palpated. The pain is worsened with hand shaking, opening jars, using a knife or fork or even using a toothbrush. Tennis elbow is more common in males, and those in the range of 30-50 years of age. It is important, however, to remember that people outside this age range also get tennis elbow frequently. Tennis players make up the majority of cases, but it is also found among baseball players, gardeners, house or office cleaners, carpenters, mechanics, and golfers.
Tennis elbow is most commonly diagnosed by a physical exam. It rarely requires an X-ray for evaluation. Treatment options for it include the following:
1.Physical therapy (with focus on eccentric exercises)
2.Elbow straps: these helps to support the muscle fibers around the elbow so that there is less strain at the area and therefore less pain
3.Applying ice to the area: this helps numb the area and decrease inflammation after participating in the inciting sporting event
4.Medications that reduce inflammation like non-steroidal anti-inflammatory drugs (NSAID), such as ibupforen
5.Steroid injections into the area: these also decrease inflammation in the area and most physicians add some numbing medications for immediate relief. This has become controversial as studies have shown great short term benefits, but limited long-term effects.
6.Platelet-rich plasma (PRP): this process has gained some public awareness, particularly when athletes have given testimonials in the media. It involves taking your own blood and spinning it down and using a specific layer that is rich in platelets. This platelet-rich plasma is then injected into painful areas like the outside of the elbow. This is best utilized for soft tissue injuries, such as tendon injuries (which include tennis elbow) meniscus tears, labral tears, and tendon injuries.
It is important to note that PRP is still considered experimental by insurance companies and is not covered by your insurance. It also works differently than most therapies that are currently available, like steroid injections and NSAIDs, which work by decreasing inflammation. However the body uses inflammation to heal areas once they are injured, so these therapies retard the body’s natural healing mechanism. PRP is a way of increasing inflammation to the affected area. This results in the body recruiting the natural healing process to promote regeneration of damaged tissue and can be a painful process while this is occurring. The studies that are being done are showing greater long term benefit over steroids, and may give credence to the old sports saying “no pain, no gain.”
Dr. Houman Danesh, Assistant Professor of Anesthesiology and Rehabilitation Medicine, works at Mount Sinai’s Pain Management and Integrative Medicine practice.