The medical term for tennis elbow is lateral epicondylitis. The problem with this term is that it suggests swelling around the epicondyle, which is the bony bump you can feel on the outside of the elbow where many forearm muscles attach at their tendons. Numerous studies show that there’s really very little inflammation and that the problem is caused by the tendon becoming degenerated (“torn up”). So a more accurate term would be epicondylopathy.

In severe cases, patients diagnosed with tennis elbow have a hard time using these forearm muscles. Even opening a door or shaking someone’s hand can be very painful. Although most physicians consider tennis elbow to be caused by overuse, Regenexx doctors commonly see middle-aged patients whose sudden development of the condition is instead related to a low-level nerve issue in the neck that causes the forearm muscles to tug at their tendons where they attach to the epicondyle. This occurs regardless of whether they’re experiencing neck pain, and it is in indicator that sometimes the neck will need to be treated concurrently with the elbow.

Traditionally, lateral epicondylitis first is treated with physical therapy. If that fails, the next step usually is a steroid shot. Research has shown steroid shots to be a short-term fix that makes the problem worse in the long run. More recently, platelet-rich plasma (PRP) injections have been shown to be more effective than steroids in treating tennis elbow.

Research published in the February 2014 issue of the American Journal of Sports Medicine has shown PRP injections to be so effective in treating tennis elbow that there is little question that this is the definitive treatment for most patients.

When compared with a precise ultrasound-guided injection of PRP, a research study on two orthopedic surgery techniques published December 24, 2015, by Arthroscopy medical journal seems barbaric. In the study reported in Arthroscopy, the authors compare tenotomy to debridement. Tenotomy is cutting the tendon or scoring it with multiple cuts, while debridement is “cleaning up” the area by removing degenerated tissue. The study shows no significant differences between the two tennis-elbow-surgery groups, including no difference in recovery times.

A sound argument can be made that, for 99.99 percent of patients suffering from tennis elbow, there is no rationale for either one of these surgeries. Regenexx doctors only infrequently have encountered a patient with tennis elbow who couldn’t be successfully treated with PRP. In the rare cases PRP therapy didn’t work, stem-cell injections have been successful.

Lateral epicondylitis is a slam-dunk indication for PRP—so much so that there is no clinical rationale for a physician to consider open surgery for tennis elbow. Why are surgeries still being prescribed when we have randomized, controlled trials showing that a much less invasive PRP shot will solve the problem? Though surgery usually is covered by insurance and PRP isn’t, it’s likely that this will change in the near future. Even if you’re covered by medical insurance, PRP likely is the more affordable out-of-pocket solution when compared with surgery. Don’t put yourself at unnecessary risk by choosing to undergo an invasive surgery when research shows that a simple shot has the power to heal your tennis elbow.

 

“Better Options for Tennis Elbow” first appeared as a post on the Regenexx blog.

Like all medical procedures, Regenexx procedures have a success and failure rate.
Not all patients will experience the same results.

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