Pain Treatment and therapy, anti-inflammatory medications
March 12 2016 by Ray Sahelian, M.D.
Tennis elbow is an overuse injury to tendons around the outer side of the elbow. As the name implies, it often arises in racquet-sport enthusiasts, but can also result from other repetitive arm motions, such as using a screwdriver, hammering or painting. Known medically as lateral elbow pain, it generally improves on its own. However, it may persist in a small percentage of people, who may even require surgery. Tennis elbow strikes 1 percent to 3 percent of the general population each year.
Most people with tennis elbow recover without physical therapy and steroid injections. The number that's often cited is that 90 percent of tennis elbow, golfer's elbow, will get better by the end of the year no matter what you do.
Tennis elbow treatment
There are many treatment options, including rest, anti-inflammatory pain medications, braces and injections of corticosteroids. However, the effectiveness of some of these tactics is questionable, and some people continue to suffer chronic pain that may eventually require surgery. For relieving painful tennis elbow, there seems to be no difference between the clinical or cost effectiveness of wearing a brace or participating in physical therapy -- or a combination of the two. So the question of which approach is best for treating this condition remains unanswered. Several studies of different methods for tennis elbow treatment, including corticosteroid injections and a "wait and see" approach as well as bracing or physical therapy, have been unable to show that any one approach is more effective or cheaper than any other.
Bone Joint J. 2013. Lateral epicondylitis: a review of pathology and management. Lateral epicondylitis, or 'tennis elbow', is a common condition that usually affects patients between 35 and 55 years of age. It is generally self-limiting, but in some patients it may continue to cause persistent symptoms, which can be refractory to treatment.
Take a break from activities that caused the condition for a few days or weeks, resting your elbow as much as possible.
Take a nonsteroidal anti-inflammatory drug (aspirin, Aleve, ibuprofen, for example) to ease pain and swelling.
Consider physical therapy to strengthen muscles in your forearm.
Steroid Injections and Tennis Elbow
Steroid injections on average produce a slight reduction of pain after three months. There is debate as to whether steroid injections offer a benefit greater than other treatment options.
Clinical Journal Sport Medicine.
2013. How effective are injection treatments for lateral epicondylitis? To
compare the effectiveness, after 3 months, of a single injection of
platelet-rich plasma (PRP), glucocorticoid (GC), or saline in reducing pain in
lateral epicondylitis. The dropout rate of 58% at 3 months showed that none of
PRP, glucocorticoid, or saline injections adequately reduced the pain and
disability of lateral epicondylitis.
Shock Wave Therapy
So-called extracorporeal shock wave therapy (ESWT) has been tried for tennis elbow, in which shock waves are focused on the problem area, with or without local anesthesia. ESWT is believed to work by causing microscopic injuries to the affected tissue that stimulate the healing process. There is little "high-quality" evidence for the benefits of many tennis elbow treatments, including shock wave therapy. A review of many studies published regarding shock wave therapy and tennis elbow found shock wave therapy was no better than placebo.
Tennis elbow surgery
Long-term relief and improved function may be possible in some chronic sufferers with arthroscopic release. Arthroscopic release is the placing a tiny video camera inside the elbow joint, and then releasing and removing the diseased tissue from the inside of the joint. It is all done through several small incisions.
Platelets for Tennis Elbow?
A simple therapy that uses the natural healing powers of blood cells called platelets could offer a new treatment for chronic cases of tennis elbow.
The one-time treatment involves drawing blood from a patient's arm and spinning it through a centrifuge in order to create a sample with a high concentration of platelets. This blood derivative, called platelet-rich plasma (PRP), is then injected directly into the injured elbow tendon. In a study, the 15 patients who received the injection showed a 60 percent improvement in pain symptoms after 8 weeks. Two years later, nearly all of the patients were essentially pain free. Platelets contain powerful growth factors. Platelet growth factors initiate a repair process in damaged tendons, which may include recruiting other cells, such as bone marrow stem cells, to the injured area. Tendons connect muscle to bone and generally have a relatively poor blood supply. Injecting an army of platelets directly into the tendon overcomes this barrier. PRP therapy is not yet widely available, however, since larger, more rigorous clinical trials have not yet been completed. American Journal of Sports Medicine, 2006.
Tennis elbow treatment and therapy questions
Q. Would serrapeptase be helpful for tennis elbow?
A. We have come across no research regarding serrapeptase and tennis elbow.
Q. I am a 48 year old male in healthy condition. I am currently taking Passion Rx and R-alpha-lipoic acid. I have tendonitis in my right elbow. I have had 5 cortisone shots with little success. Are there any supplements I can take to help reduce the inflammation and/or pain.
A. We have not seen any studies regarding the treatment of tennis elbow tendonitis with the use of natural supplements. If anything could help it may be Joint Power Rx but we have no feedback from users of this supplement in regards to tennis elbow pain.
I have suffered
with tennis elbow for over 2 years. I have had multiple therapies (cortisone,
p.t. ultrasound and rest) I have been recommended surgery and this is simply not
an option as I have had numerous orthopedic surgeries with adhesions
complicating everyone of them. I am hoping you can help me locate a dr. who is
doing this injection. Couldn’t tell if it is still considered experimental or
Sorry, I do not keep a list of doctors for such referrals.