I'm self-insured so trying to spend my money wisely with what seems like a bad case of tennis elbow. Do you recommend X-rays? MRIs? CT scans? What's the best route to take when dealing with this particular problem?
Despite over 100 years of study and treatment, lateral epicondylitis, otherwise known as "tennis elbow" can be a difficult problem to treat. Recent research has shown us that partial tears of the extensor carpi radialis brevis (ECRB) tendon just don't heal right. But the reason for this remains unknown. After the acute injury, repetitive microtrauma results in an area of fibrosis (scarring) rather than inflammation. Finding ways to successfully treat this problem is a challenge health care providers face every day.
The first thing to do is confirm that the problem is really lateral epicondylitis. Caucasian women between the ages of 35 and 50 are affected most often. But those kinds of demographics aren't enough to make a diagnosis. The clinical presentation is another helpful clue. Pain along the outside of the elbow that goes down the forearm is a telltale sign. There may be tenderness right over the bone. Pain with gripping or lifting is common. And painful symptoms are brought on or increased when the examiner resists the movement of wrist extension.
This collection of symptoms usually directs the physician to consider ordering some imaging studies. X-rays are often ordered but research shows that in the case of lateral epicondylitis, they aren't really needed or helpful unless the patient fails to improve with conservative (nonoperative) care. MRIs can be more useful but they are also more expensive. An MRI may show areas of tendon thickening, avulsion of the tendon (avulsion means the tendon pulls away from the bone), and severity of damage.
Ultrasound is another way to get a look inside the arm to see what's going on. It's a less expensive, less invasive test but also less likely to provide accurate information. With all imaging studies, it's clear that the severity of the image doesn't always match the person's symptoms and vice versa. In other words, you can have extreme pain and find very little change on diagnostic imaging. Or there can be severe signal changes seen with MRI or ultrasound in someone who is symptom-free or has minimal symptoms.
The experts do agree that conservative care should be first and foremost. And diagnostic imaging is not required before heading in this direction. Conservative care has the intended effect in up to 90 per cent of all cases. Patients report decreased pain, improved strength, and pain free return of full function of hand, wrist, and forearm. It may take up to a full year to get those kinds of results but most patients agree it is worth the time and effort.
Namory D. Bagayoko, MD, and Stephen F. Brockmeier, MD. Current Controversies in the Management of Lateral Epicondylitis. In Current Orthopaedic Practice. September/October 2012. Vol. 23. No. 5. Pp. 480-485.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.