Epicondylitis : Elbow tendonitis

Diagnosis of epicondylitis (tennis elbow)

What is epicondylitis (or “tennis elbow”)?

Tennis elbow is an inflammation of the tendons located on the lateral side of the elbow, attached to the epicondyle, the lateral bony prominence of the humerus.

Epicondylitis may be occasional or chronic. This condition particularly affects athletes who overuse their upper limbs, such as tennis players. This is why the condition is called “tennis elbow” in English.

However, this elbow tendinitis can affect all types of people. A simple injury occurring during daily activities may also cause epicondylitis. It can also result from repetitive strain on the elbow over long periods, particularly in certain professional activities.

There is a similar form of tendinitis related to epicondylitis: medial epicondylitis. This condition affects the inner side of the elbow, on the little finger side, and causes the same type of chronic pain. Medial epicondylitis can also be treated surgically if medical treatment fails.

Symptoms of lateral elbow tendinitis

This elbow tendinitis is a condition that can cause disabling pain during everyday activities and sports. The pain may last for several months or even several years.

Without treatment, epicondylitis may force patients to permanently stop sporting activities or change their work duties.

How is epicondylitis diagnosed?

The diagnosis of this elbow tendinitis is mainly based on a clinical examination. The typical pain of epicondylitis can be reproduced by applying pressure to the tendon insertion on the lateral side of the elbow and through specific examination maneuvers.

If there is doubt regarding an early tendon rupture or associated lesions, an X-ray or MRI scan may be requested.

Medical treatment for epicondylitis

The treatment of elbow tendinitis is initially conservative. It involves stopping the activities responsible for the pain, combined with painkillers and anti-inflammatory medication.

This treatment is complemented by specific physical therapy, including deep transverse friction massage techniques, which are often very helpful, sometimes combined with extracorporeal shockwave therapy sessions.

One or more corticosteroid injections may also be proposed.

Medical treatment for epicondylitis is often long and challenging. Pain relief is frequently incomplete. Surgical treatment may then be considered.

Surgical treatment for epicondylitis

Summary: Surgical treatment for epicondylitis

• Procedure duration: Outpatient surgery.
• Anesthesia: Regional anesthesia, only the arm is numbed.
• Immobilization: Arm sling for 8 to 10 days.

When should surgery be considered for epicondylitis?

Surgery is considered when medical treatment has failed.

The procedure is decided after discussion with the patient when medical treatment has not provided sufficient improvement after several months, with persistent pain and functional impairment.

Procedure overview

The procedure is performed under regional anesthesia (only the arm is numbed). A tourniquet is placed at the root of the limb to prevent bleeding.

This elbow surgery procedure consists of releasing the damaged tendons at their bony insertion in order to reduce tension and replacing the most damaged fibers with a flap of healthy nearby tendon tissue.

A 4 to 5 cm incision is made on the side of the elbow. The tendons are released by selective sectioning of their aponeurosis and at their bony insertion. Degenerated bone and tendon tissue are removed.

If necessary, one of the branches of the radial nerve that may be compressed by the tendons will be released.

The resected tendon segment is then replaced with a tendon flap, meaning a portion of a healthy tendon located nearby.

A PRP injection, using growth factors taken from the patient’s own blood, is often performed at the end of the procedure to enhance tendon healing.

Finally, the skin is closed with an intradermal running suture in order to reduce scar visibility.

Recovery after surgery

An arm sling immobilization must be maintained for about ten days.

Physical therapy should begin two weeks after surgery.

In general, return to sports activities involving the operated arm should wait at least 2 months, while returning to office work is usually possible after a few weeks.

Results of surgical treatment for elbow tendinitis

Surgery is often the most effective treatment for improving symptoms and reducing pain caused by epicondylitis that is resistant to medical treatment.

Functional outcomes are generally very satisfactory. However, improvement is not always complete, and some pain or moderate functional discomfort may occasionally persist.

Possible complications after surgical treatment of epicondylitis

• The main complication is persistent pain or functional discomfort.
• The risk of infection is rare but always possible and may require antibiotic treatment or additional surgery.
• Nerve or tendon injury is also always possible.
• Elbow stiffness, with swelling and pain, may persist for several months.
• Complex regional pain syndrome, with stiffness, swelling, and pain that may evolve over several months. Unfortunately, this condition cannot be predicted before surgery and is difficult and lengthy to treat, often leaving residual functional limitations and loss of mobility.
• Stopping sports activities or even changing professional duties may become necessary despite surgery, due not to the surgical procedure itself, but to the initial tendon damage.