Deborah Howell (Host): We've all heard the term tennis elbow. So what is it and when do you know you might have it? Dr. Michael Osterholt, sports medicine physician and Washington State University Athletics team physician is with us today and he is here to break down the causes, symptoms and treatment of tennis elbow. Welcome Dr. Osterholt.

Michael Osterholt, MD: Thank you. I appreciate you having me on.

Host: Absolutely. Oh my gosh, I've had it. Maybe you've had it. So what is tennis elbow and what does it feel like?

Michael Osterholt, MD: So it is a disorder of the lateral epicondyle, the extensor mass. So the muscles that attach to the outside of your elbow. It's an overuse injury of that tendon mass there.

And from what I've heard and what patients described to me is it's a sharp, achy, pain and when it gets severe enough, it's with any activity that they do, any repetitive twisting, turning, picking things up, seems to be a lot with grip strength, or pain with grip. And then, the other thing we see is when the pain gets severe enough, their grip strength seems to decline.

 So it's really that pain on the outside. And then, the decreased strength that we see.

Host: So what are the common symptoms of tennis elbow?

Michael Osterholt, MD: Kind of going along that lines, I think, people a lot of times will say, if I go to open a doorknob. So, twisting your arm, to open a doorknob can cause significant pain. Opening a jar of something can cause significant pain. If you're someone who's like a mechanic or working on a car and you have a wrench, things like that can cause a lot of pain.

So I tend to see that it's kind of a pain response to activities and kind of the more severe it gets, the more pain it gets with even basic movements like people just moving their wrist or moving, to do something without even lifting or doing anything.

Host: Right, and tennis elbow ain't just for tennis players. What actually causes tennis elbow?

Michael Osterholt, MD: Yeah, it's kind of interesting because we certainly do see it in tennis players and what it is, is, when tennis players do their backhands, if you're not having the right biomechanics of tennis and you tend to use more of your wrist, you're going to engage those extensor muscles and it causes a lot of strain on 'em.

But most of the tennis players we see, who play it frequently, you know, they have fairly good biomechanics. It's usually the people that are like haven't played tennis ever, and I wanted to decide to go out and play for an entire weekend. But we most commonly see it in people who have like manual labor where they're doing, repetitive motions day to day.

We see it in people who knit, artists who have paint brushes, really anyone where they're, constantly repetitively engaging that wrist to do motions.

Host: Yeah, I'm a pickleball player as well, and people add a lot of lead tape to add weight to their paddles so that extra weight actually makes the paddle much heavier and they can get tennis elbow.

Michael Osterholt, MD: Yes, exactly. I've played pickleball before and you tend to want to kind of flick your wrists a lot more.

Host: Yeah, the backhand flick.

Michael Osterholt, MD: So, it wouldn't surprise me if it was even more common in something like pickleball.

Host: So any groups more likely than others to develop tennis elbow?

Michael Osterholt, MD: Like you said, we see it in certainly people who play racket sports. We see it in people who have manual labor jobs or they're constantly lifting or constantly moving. And then I've mentioned it a little bit before, but, people who are involved in arts and who are repetitively painting, coloring, doing charcoal, things like that where you have kind of those fine movements at the wrist and you're constantly engaging those muscles.

There isn't necessarily a specific age, I would say, age wise and sex wise, it seems to be pretty common throughout, age and sex ranges.

Host: How is tennis elbow diagnosed, and then of course, how do you treat it?

Michael Osterholt, MD: Diagnosis, most of it is based on our physical exam. Sometimes we will get x-rays and the biggest thing on x-rays is we're looking for arthritis because that seems to be a diagnosis that can be frequently missed if you have arthritis of the radial ulnar joint, that is kind of in a similar location of where you can have tennis elbow.

So I think that's the biggest thing we're ruling out with x-rays. And then with the physical exam, I mean, we're looking in younger populations, really a lot younger kids who can, sustain fractures or injuries, supracondylar injuries, we're pressing there, to make sure that we're not missing something there.

And then the location, we find that lateral epicondyle. We go just distal to that, we press on that extensor mass and usually it lights people up. And that's kind of a very, very focal area of pain that if that's where you're having pain, it's really not much else that it could be. There's some provocative maneuvers we do as far as we get your arm extended out and we, kind of rotate your wrist down and flex your wrist, and that seems to stretch that area and that can cause a lot of pain. And then, I have the expertise of being able to utilize ultrasound. So I can put an ultrasound on that area and I can see disorganized tendon tissue. I can see increased blood flow or vascularity to the area. And that tendon tends to be a lot thicker over time.

Host: Yeah, and you can't just say to the patient, organize your tendons, you know.

Michael Osterholt, MD: Yes.

Host: You need to do some physical things for them.

Michael Osterholt, MD: Yeah. So, as far as treatment goes, we tend to break it up into is this kind of an acute inflammatory response where, you know, weren't previously having any pain whatsoever and now you've had pain for the last few days. When that's the case, you we usually tell people to rest your arm, rest your hand. Try not to do any repetitive lifting. Icing the area three times a day for 15 minutes, utilizing anti-inflammatories. And I'd say the vast majority of the time, if you provide that adequate rest and decrease that inflammation, then that kind of short term period can improve. But then we get those people that they have sort of long-term chronic issues with the tendon, and that seems to be a, a little bit more difficult challenge.

That's when we get them into physical therapy. We work on scraping soft tissue, ultrasound. There's all kinds of different modalities that we do in order to help treat that conservatively. If those don't work, then we run down the line of injections, either, we do PRP, we do prolotherapy in our clinic, which are injection options for kind of chronic tendon disorders.

Host: Are they similar to cortisone shots?

Michael Osterholt, MD: They're different. We've learned with tendon disorders that steroid shots help in the immediate time period, people tend to get pretty good relief within the first, four to eight weeks. But long term, steroid injections don't tend to help a whole lot. So we've actually gone away from doing steroid injections into tendons for the most part.

And there's been some good research. It shows if you do absolutely nothing for it versus do a steroid injection about a year out, your almost identical outcomes.

Host: And do you ever use a splint for someone who just can't stop playing their sport or?

Michael Osterholt, MD: We do. I actually, I fairly commonly will recommend a splint because if we can immobilize the wrist, like you said, it prevents them from twisting, turning at the wrist, which is where those muscles attach. So if I see someone and they've had symptoms for less than two weeks, I'd recommend a splint, anti-inflammatories, ice, and I'd try to get them into physical therapy.

Host: And if the patients behave like they should, tennis elbow is not that big a deal, right?

Michael Osterholt, MD: Yeah, I mean, if we take the interventions to tackle it head on, I think, the vast majority of people can get back to where they were prior, and kind of do all the activities that they want to do.

 The good thing about tendon disorders and conditions is there's a time component to it.

A lot of these disorders do get better with time. A lot of our interventions are really trying to expedite the time and make your pain better faster.

Host: Great. Anything else you'd like to add before we wrap up?

Michael Osterholt, MD: I ran through rapidly, um, a lot of the interventions we do and we, we really do take it on a, patient by patient basis, kind of where your symptoms are at, how long you've had it, and try to address your needs as a person and what you're wanting to get back to.

 Yeah, and I think that we utilize all those different techniques in a variety of different ways, and our goal is to get you to do what you want to do.

Deborah Howell (Host): That's it. That is the goal. Well, Dr. Osterholt, thank you so much for being on the podcast today. Learned a lot about tennis elbow.

Michael Osterholt, MD: Yes. Thank you for having me. I appreciate it.

Host: And if you're in need of sports medicine or orthopedic care, visit inlandortho.net to schedule an appointment or explore express care, walk-in locations and hours. This has been The Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.