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An Unusual Cause For Refractory Lateral Elbow Pain

Written by
Dr. Saseendar S
and medically reviewed by iCliniq medical review team.

Published on Nov 29, 2016 and last reviewed on Oct 20, 2021   -  4 min read


This article stresses the need for clinical suspicion and adequate assessment in refractory patients to provide early functional improvement and pain relief. First, let us discuss lateral epicondylitis in detail.

An Unusual Cause For Refractory Lateral Elbow Pain

What Is a Tennis Elbow?

Tennis elbow or lateral epicondylitis is a painful condition of the elbow. It arises from the tedious stress of the extensor muscles and tendons during repetitive movements of the forearm and the wrist. These kinds of repetitive movements result in fatigue of the forearm, which leads to overloading of the tendon. This, in turn, causes pain and inflammation of the tendon called tendonitis. Further, it leads to a degenerative condition called tendinosis, which altogether results in tendon tearing.

Who Is Prone to Get Tennis Elbow or Lateral Epicondylitis?

Despite its name, this condition is more commonly associated with work-related repetitive elbow and wrist movements like washing clothes, wringing clothes, hammering, and carpentry than in tennis players. It is seen in people who vigorously do repetitive actions that use the forearm, hands, or wrist. The following are the group of people who are predisposed to tennis elbow:

What Are the Symptoms of Tennis Elbow or Lateral Epicondylitis?

How Is Lateral Epicondylitis or Tennis Elbow Diagnosed?

How Is Tennis Elbow or Lateral Epicondylitis Treated?

In its early stages, the condition responds well to rest, ice packs, analgesics, and anti-inflammatory drugs. However, later stages usually require intervention in the form of steroid injection and then surgical treatment.

1. Rest: Giving adequate rest to the tendons aids in healing.

2. Medications: Non-steroidal anti-inflammatory drugs like Naproxen and Ibuprofen help in reducing the pain and inflammation associated with lateral epicondylitis.

3. Steroid Injections: Corticosteroids are injected into the site of pain, which helps in relieving pain and inflammation. Ultrasound-guided steroid injections are given to a few individuals to determine the exact location of the injection site.

4. Braces: A counterforce brace can be worn to relieve the tension exerted on the muscles and tendons.

5. Physical Therapy: Physiotherapy exercises help in strengthening the muscles of the forearm and help in enhancing the grip. Ultrasound, massage, and muscle-stimulation techniques help reduce pain and inflammation and improve function.

6. Extracorporeal Shock Wave Therapy: With the help of this therapy, the scar tissue is broken down, leading to improved blood flow to the area of damage.

7. Platelet-Rich Plasma Therapy: In this therapy, a little amount of blood is taken with the help of PRP injection, platelets are removed, and the concentrated platelets are injected with the help of an ultrasound.

8. Minimally Invasive Tenotomy: It is a minimally invasive procedure in which the degenerative tendon tissue is hydro-resected with the help of a needle device.

If the non-surgical therapies do not help, arthroscopic surgery, tendon repair, or tendon debridement is recommended. It takes around four to six months to recover from surgery.

How Is the Prognosis of Lateral Epicondylitis?

Lateral epicondylitis is usually treated by non-surgical therapies in about 95% of people, and the symptoms typically subside in a period of six to 18 months. However, few might require surgery. After surgery, recovery of symptoms usually occurs in one year

How Can We Prevent Lateral Epicondylitis or Tennis Elbow?

At times, certain unusual conditions of the lateral aspect of the elbow can mimic or co-exist with a tennis elbow and can cause refractory pain.

Chronic Non-responsive Lateral Elbow Pain:

The use of Duloxetine, a selective serotonin and norepinephrine reuptake inhibitor in chronic refractory elbow pain, which does not respond to any other non-surgical and surgical therapies, is under study.

Here is a case report of a young female who had chronic non-responsive lateral elbow pain.

This report describes an unusual cause of lateral elbow pain that could be missed during the management of refractory tennis elbow.

This stresses the need for clinical suspicion and adequate assessment in such refractory patients to provide early functional improvement and pain relief.

Consult an orthopedician online for queries regarding chronic elbow pain --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

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Last reviewed at:
20 Oct 2021  -  4 min read




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