Taking a Swing at Tennis Elbow, with or without Surgery

Lateral epicondylitis--commonly known as tennis elbow--is pain along the outside of the elbow that comes from repeatedly twisting or straining tendons in the forearm. This condition can be treated with rest, ice, and physical therapy. But sometimes the pain doesn't go away. In these cases, patients may need surgery. The purpose of this study was to single out factors that may lead patients to have surgery for tennis elbow.

The participants included 97 patients with elbow pain from repetitive wrist and forearm activity. The patients were half men and half women. Their average age was 46.

Patients were given a specific treatment program. First, they were told to rest and ice their elbows and wear a brace. They also went to physical therapy three times a week for six weeks. In some cases, they took anti-inflammatory medications. If the pain was still severe, they also received steroid injections.

When the pain subsided, patients were taken off anti-inflammatory medications. They continued to do physical therapy, with greater focus on strengthening the wrist and forearm. At this point, patients usually went back to their normal activities.

This treatment was successful for roughly 75 percent of patients. However, the remaining 25 percent went on to have surgery.

Patients who had already tried the elbow treatments used in this study were twice as likely to have surgery. Also, the more steroid injections patients received, the more likely they were to have surgery. Patients who had zero or one injection only had surgery 12 percent of the time. But patients whose pain did not go away after one injection had surgery nearly half of the time. And patients whose pain lasted even after getting two injections had surgery 78 percent of the time.

Overall, most of the patients (92 percent) said their results were good or excellent a few years after treatment. This did not change depending on whether or not they had surgery.

The authors conclude that most patients with tennis elbow respond well to conservative treatment. Steroid injections seem to help up to a point, but the benefits tend to decrease with each injection. In general, when nonoperative treatment doesn't reduce patients' pain, it's unlikely that ongoing treatment of this sort will give patients much additional relief. When this is the case, surgery might become the next best choice.

References: Richard E. Bowen, MD, et al. Efficacy of Nonoperative Treatment for Lateral Epicondylitis. In The American Journal of Orthopedics. August 2001. Vol. 30. No. 8. Pp. 642-646.