Houston Methodist. Leading Medicine

Elbow FAQ

Question:

I am stumped and so is my surgeon (I think). I have a case of chronic pain from tennis elbow along the outside of my elbow. A tiny tissue biopsy showed there isn't any inflammation. So why hasn't anything we've done for treatment helped me? I even had an epicondylectomy (if I spelled that right) and still it hurts. Do you have any possible explanation?

Answer:

Pain along the outside (lateral) elbow from chronic overuse and repetitive activities describes what many patients with chronic epicondylitis experience. Conservative treatment (without surgery) isn't always successful. The reason chronic tennis elbow doesn't get better sometimes is because the tiny microtears of the extensor tendons that are involved don't heal fully. A partial repair gets interrupted and ends in distortion of the collagen fibers and degeneration of the tendon fibers. Many microscopic studies of the affected tissues have proven there is a lack of actual inflammation in these chronic cases. When nonoperative treatment fails, surgery to release the tendon from its attachment to the bone is often suggested. That's the epicondylectomy you had (and yes, you did spell it correctly!). A failed epicondylectomy may be the result of a second compounding problem known as radial tunnel syndrome. Radial tunnel syndrome happens when the radial nerve is squeezed where it passes through a tunnel near the elbow. The symptoms of radial tunnel syndrome are very similar to the symptoms of tennis elbow (lateral epicondylitis). There are very few helpful tests for radial tunnel syndrome, which can make it hard to diagnose. It is possible that the radial tunnel syndrome is really the reason why some patients do not respond fully to other treatment (conservative and/or operative) for epicondylitis. When surgery is performed, the surgeon can take a look in the area and see if there might be other potential causes for the persistent pain. Further study of this problem is needed to determine whether additional treatment of this second problem will eliminate the painful symptoms and weakness. In your case, a follow-up arthroscopic examination may help identify secondary problems that might be contributing to your ongoing problem. If you feel your surgeon has done all he or she can do for you, you may want to seek a second opinion and ask about ways to determine what's wrong. Nicholas E. Rose, MD, et al. Denervation of the Lateral Humeral Epicondyle for Treatment of Chronic Lateral Epicondylitis. In The Journal of Hand Surgery. February 2013. Vol. 38. No. 2. Pp. 344-349.

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