Tennis elbow (lateral epicondylitis)

The wrist extensor muscles — the ones that lift the back of the hand — share a common tendon origin on the bony point on the outside of the elbow. Repetitive gripping and wrist extension overloads that origin, and over time the tendon becomes degenerative rather than truly inflamed, which is why rest alone is often not enough to settle it.

Despite the name, most patients with tennis elbow do not play tennis. Racquet sports are one cause, but the condition is at least as common in people whose work involves repetitive gripping, lifting, tool use or keyboard and mouse work.

Symptoms localize to the outside of the elbow and the back of the forearm, and are provoked by gripping.

Elbow pain that has persisted beyond a few weeks of rest and activity modification is worth an evaluation — both to confirm the diagnosis and to start the treatment that actually changes the tendon. Pain on the outside of the elbow is occasionally something else, including referred pain from the neck or a ligament injury, and the examination is designed to distinguish those before treatment starts.

Tennis elbow is primarily a clinical diagnosis: tenderness at the extensor origin and pain reproduced by resisted wrist extension. X-rays are often taken to rule out arthritis or other bony problems, and an MRI or ultrasound is reserved for cases that are not behaving as expected or when surgery is being considered.

The mainstay of treatment is a structured loading program for the wrist extensors — eccentric and progressive strengthening — combined with modification of the activity that is overloading the tendon. A counterforce brace can ease symptoms during activity, and a cortisone injection can provide short-term relief when pain is blocking rehabilitation.

For persistent cases, platelet-rich plasma is among the most reasonable uses of PRP in orthopedics, with more supportive evidence here than for most conditions. It is self-pay because insurers do not currently cover it — details are on the PRP injections page.

Surgery is considered only when pain remains disabling after six to twelve months of well-managed non-operative treatment — a minority of patients. The procedure removes the degenerated portion of the tendon and is performed as an outpatient, with return to gripping and lifting built back gradually through a rehabilitation program.

The decision to operate is made together, after a fair trial of everything else — most patients with tennis elbow never need it.

Dr. Horner is a board-certified orthopedic surgeon fellowship-trained in sports medicine at Rush University Medical Center, with an interest in biologic treatments including platelet-rich plasma. The plan is built around the least invasive option with a reasonable chance of working, with a defined checkpoint rather than open-ended waiting.

Patients are seen at Oak Brook on Mondays, Little Village on Wednesdays and St. Charles on Thursdays.