Houston Methodist. Leading Medicine

Elbow FAQ

Question:

Do you think it's reasonable that my tennis elbow is going to take a full year to heal? That's what both the surgeon and the physical therapist said. That seems like a very long time to me. I usually heal fairly quickly from most other injuries. Why does this take so long?

Answer:

Acute tennis elbow, known as lateral epicondylitis often occurs as a result of repetitive overuse of the elbow extensor tendons. In the beginning of the injury, the body responds to the microtrauma with an inflammatory process. If all goes well, the body regenerates the area and the person recovers. But in some cases (especially when the repetitive forces continue during the body's attempt to heal), there is degeneration of the tissue and failure rather than a healing response. In the end, the tissue present at the injury site is poorly organized collagen, fibrosis, and scarring. The final product is referred to as tendinosis or tendinopathy rather than tendinitis. Tendinopathy describes a chronic condition present with epicondylitis -- there is no active inflammation going on. Microscopic studies have shown us that the area has poorly organized collagen fibers. As mentioned, there is scar tissue and an area where acute inflammation was present in the beginning but just never healed right. Tendinopathy is more of a degenerative condition than one of inflammation. This is the scenario that the orthopedic surgeon and physical therapist are responding to. Research and ongoing studies show that many people respond well to three to six months of conservative (nonoperative) care. That includes pain medications, activity modification (stopping the repetitive motions), splinting, and physical therapy. The therapist will assist with pain control, splinting, stretching, and appropriate exercises for this problem. Sometimes steroid injections, platelet-injection (blood) therapy, or shockwave therapy might be recommended or tried. There are mixed results for each of these treatment approaches. Steroid injections provide short-term pain relief but don't really have any long-term benefit (i.e., patients who don't have the injections do just as well three to six months later). There may be some ups and downs during that time, especially for people who start to feel better and then overuse the area again before full healing has taken place. Microtrauma can create some acute inflammation on top of a chronic problem. The result is a cycle that prevents and extends healing -- sometimes for months. Surgery is reserved for patients who faithfully follow the protocol for chronic tennis elbow and still end up with pain, loss of motion, weakness, and decreased function. But for most patients, the process of restoring normal elbow function does indeed take six to 12 months. That is what is referred to as the natural history of chronic tendinopathy. Samuel A. Taylor, MD, and Jo A. Hannafin, MD, PhD. Evaluation and Management of Elbow Tendinopathy. In Sports Health. September/October 2012. Vol. 4. No. 5. Pp. 384-393.

*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.
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