Signs and Symptoms
Symptoms usually build gradually over weeks to months:
- Pain or burning on the outside of the elbow that may spread into the forearm
- Pain when gripping, lifting, shaking hands, turning a doorknob or holding a coffee cup
- Weaker grip strength
- Tenderness when you press on the bony bump on the outside of the elbow
What Causes It?
Tennis elbow is an overuse problem. Repeated gripping and wrist motions strain the tendon, especially the one called the extensor carpi radialis brevis. Over time the tendon develops tiny tears and degenerative changes rather than simple inflammation.
It is most common between ages 30 and 60. Racquet sports, golf, carpentry, painting, plumbing, cooking, gardening and heavy keyboard or mouse use can all contribute.
How We Diagnose It at POPB
Diagnosis is usually made by history and examination. Your physician presses on specific spots and asks you to extend your wrist or fingers against resistance to see what reproduces the pain.
X-rays in our office can rule out arthritis or other bone problems. Diagnostic ultrasound, available on site, can show tendon thickening and tears, and MRI is used occasionally when symptoms do not follow the usual pattern. Your physician will also check for a pinched nerve in the neck or forearm, which can cause similar pain.
Non-Surgical Treatment Options
Most people get better with non-surgical care, though it often takes months. Options include:
- Rest from the activities that trigger pain and changes to your grip, tools or technique
- A forearm counterforce strap or a wrist brace to reduce strain on the tendon
- Physical or hand therapy in our office, with stretching and strengthening exercises that load the tendon gradually
- Anti-inflammatory medication for short periods if appropriate for you
- Cortisone injection, which may give short-term relief but is used selectively, since repeated injections can weaken the tendon
- PRP (prepared from your own blood) or shockwave therapy for stubborn cases. Evidence is still developing and results vary. PRP is usually not covered by insurance, and coverage for shockwave varies by plan.
Surgical Options
Surgery is considered only when significant pain continues after roughly 6 to 12 months of consistent non-surgical treatment. Dr. Tucker and Dr. Wolfson can remove the damaged portion of the tendon and repair the healthy tissue, using an open approach through a small incision or an arthroscopic approach. The choice depends on your anatomy and the surgeon's assessment.
This is an outpatient procedure, performed at an area surgery center.
Recovery
With non-surgical treatment, symptoms typically improve over 6 to 12 months, and many people feel better sooner. After surgery, you may wear a splint briefly, then begin therapy to restore motion and strength. Many people return to light activity within a few weeks and to full activity and sports in about 3 to 6 months. Timelines vary.
Our physical and hand therapists work in the same office as your physician, so exercises can be adjusted quickly if the elbow flares.
Insurance and Cost
Office visits, X-rays, therapy, bracing, cortisone injections and medically necessary surgery are generally covered by Medicare, most commercial PPO plans and workers' compensation, subject to your deductible and co-pay. HMO and managed-care plans require a primary care referral before the visit.
PRP is usually not covered by insurance. Shockwave coverage varies by plan, so ask our team before you start. If tennis elbow is related to your job, we can handle the workers' compensation documentation.
When to Be Seen
Make an appointment if elbow pain lasts more than a few weeks despite rest, interferes with work or daily tasks, or weakens your grip. See a physician promptly if you have numbness or tingling in the hand, swelling, or pain after a fall, which can point to a different problem.
