Transcription:
Do You Suffer from Tennis Elbow?

Melanie Cole (Host):  Tennis elbow is a painful condition of the elbow caused by over use. Not surprisingly, playing tennis or other racket sports can cause this condition; however, several other sports and activities can also put you at risk. My guest today is Dr. Robert Boretz. He's a board certified orthopaedist at Summit Medical Group. Welcome to the show, Dr. Boretz. So, tell us what is people hear that term 'tennis elbow', what is it?

Dr. Robert Boretz (Guest):  Well, the first thing I'll start saying is that tennis elbow is not a great name for this condition because there's a large majority of people who get this problem do not play tennis. So, I guess that's how it's traditionally described but it’s pain on the outside of the elbow due to an overuse of the tendons that extend your wrist. So, it can occur from any type of repetitive activity.

Melanie:  So, it's pain on the outside of the elbow. How would someone know if this lateral epicondylitis or tennis elbow is what they have, or if it's just a fleeing pain?

Dr. Boretz:  Well, obviously, it's always worthwhile seeing your physician for a proper diagnosis but, in general, a lot of patients come in having diagnosed themselves and the internet is a great resource today. But, pain essentially on the outside of the elbow. So, if you're looking at your elbow and towards the outside is a little bony prominence that is right in that area. If it is very tender to touch and it's hurting and your arm has pain when lifting objects or extending your wrist, that's typical of the diagnosis.

Melanie:  So, what causes it if it's not only specifically racket sports? What is the movement specifically that causes this pain?

Dr. Boretz:  Well, it's not one movement, but what's happening is there's what we call is a “tendonosis” which is a wear and tear of the tendon. That's one thing that's a common misnomer. It’s that it is actually not an inflammatory condition like the name implies. The proper name is, as you mentioned before, lateral epicondylitis. It's really not an inflammation of the epicondyle which is the little bony bump on the side of your elbow. It's more of a tendonitis or a wear and tear of the tendon insertion in that area. So, unfortunately, it is age related and tendons essentially, with age, go through a process where they resist stress less and with repetitive activities, like using your wrist and extensions or putting your wrist up towards the sky, that's the type of activity, believe it or not, that actually results in the problem at your elbow. It's not at the elbow itself. It's at the wrist.

Melanie:  So, golfers might suffer from this when they're hitting the ground, or from that movement, if they use their wrist too much. Who else is at risk besides?

Dr. Boretz:  Well, any type of racquet sport. So, in addition to tennis, I've actually seen racquetball players get this, as well as badminton. But, like I said, the majority of people don't have a history of using a racquet sport. It's just sort of a gradual, insidious onset of pain with normal activities. It's often present for weeks or months before a patient presents it the physician.

Melanie:  So, if you do start to feel this pain, Dr. Boretz, what do you recommend patients do?

Dr. Boretz:  Well the fortunate thing is that 70-80% of patients do get better with conservative treatment and the basics in orthopaedic treatment such as ice and rest. Those things are very important. It's a tendon that's been overused and if you're able to rest it, that helps a lot. So, it's easy to say, “Don't use your wrists,” but that's not really practical because in everyday life, you have to use your arm. So, one of the mainstays of treatment is to use what's called a “counterforce brace”, which is a brace that goes on the upper third of the arm. A lot of people are just seeing wearing this out. It's a common condition but it's a little bubble or a pressure point on the muscles that helps to sort of act as a dampener and take away some of the force at the elbow where the tendon is the degenerating and tearing.

Melanie:  What about ice or anti-inflammatories?

Dr. Boretz:  Those things are helpful for symptomatic relief. The anti-inflammatories and ice, obviously, don't cure the problem but, as I said, the majority of people get better with just observation, or time, and avoiding if you're playing tennis or you are doing a particular activity that started your symptoms, then modifying that, and wearing a brace; using ice on the elbow; anti-inflammatories and other treatments as well, such as physical therapy.

Melanie:  Does it ever come to where you might need a steroid injection?

Dr. Boretz:  Yes. That's a little bit controversial. Just backing up a step, in addition to the elbow brace, sometimes actually putting a patient in a wrist brace could be very helpful because, like I said, immobilizing the wrist prevents that repetitive wrist activity of raising your wrist up which is what causes the problem. So, I try all those things as my first modality of treatment. I try behaviour modification, bracing, icing, rest. Cortisone shots definitely help in the short term but there's been a study showing that potentially in the long term, it actually is less favourable. But, I have to say, with that said, often it's an option I offer to the patients because when a patient has severe pain and it's affecting the activities of daily living and it gets to the point where it would affect your sleep, cortisone shots could be very helpful for short term symptoms.

Melanie:  Is there any way to prevent it? I mean, if somebody is a tennis player, a racquetball player, a golfer, or, as you said, it’s age related. Is there anything you can do to prevent it?

Dr. Boretz:  Well, with respect to specifically to playing tennis, the thing that is recommended is, if you're developing symptoms of tennis elbow, have a tennis instructor take a look at your swing because sometimes people are overusing those wrist extensors so they're doing a sort of snap back, especially in a backhand. It depends on, obviously, which elbow is involved. But, if it's your right hand and with your backhand position, if you're sort of snapping your wrist in an extension, that can result in symptoms. They do think overuse or playing too long, playing too often, which is a common thing we see especially with young athletes now. The kids are doing the same activity day in and day out. Some people feel the size of the racket, some of them are too oversized. That's a contributing factor, as well as the weight of the racquet. A lighter racquet is better.

Melanie:  That's a very good advice and what do you see on the horizon? Do you see any new developments? Are they trying PRP or things like that for this?

Dr. Boretz:  Yes, there definitely has been a trend towards trying alternative treatments. Surgery is still an option. Unfortunately, things like PRP to this point aren't proven. There are some studies but none of them show clear benefit over control studies. So, with respect to modalities such as PRP, which is injecting platelet rich plasma into the point of tenderness. So, just as a review, PRP is taking a patient's blood out, spinning it down and taking the platelet rich plasma and injecting it directly into the tendon. The concept is that this rich plasma is going to have healthy healing factors and growth factors and proteins that will help the tendon heal. It sounds good but the data is not really clear yet whether this is a benefit. Unfortunately, most insurance carriers, therefore, aren't paying for it.

Melanie:  So then, tell us about your team at Summit Medical Group. Give your best advice for patients with tennis elbow. What you really want them to know and what you tell them every single day?

Dr. Boretz:  It's best catching problems early than letting them sit for a while. So, once pain develops, if the patient makes a diagnosis at home or even obtaining a brace and backing off on activity prior to an office visit is very beneficial Also, early diagnosis is helpful so get into the position for an evaluation. If you're playing tennis, modify what you're doing. All those things are helpful because tennis elbow, unfortunately, can be a chronic condition that can go on for more than twelve months.

Melanie:  And, why should they come to Summit Medical Group for their care?

Dr. Boretz:  We have many orthopaedic surgeons who specialize in upper extremity care and are familiar with this diagnosis, and the different treatment options available. I think we have a great team of physicians to treat this problem as well physiatrists.

Melanie:  Thank you so much, Dr. Boretz. It’s great information. Thanks for being with us today. You're listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That's SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.