tenniselbow1The primary symptom of lateral epicondylitis, or tennis elbow, is pain at the lateral (outer) aspect of the elbow and upper forearm. This pain primarily occurs with extension of the wrist and/or turning the palm upward (supination), though may also occur with extension of the fingers (particularly the middle finger). It is exacerbated by exertion of the involved muscles with function or against added resistance. The area is generally tender to palpation.

The muscles most commonly involved in tennis elbow are the wrist extensors – the Extensor Carpi Radialis Brevis (ECRB) and Longus (ECRL), and perhaps to a lesser extent, the Extensor Digitorum Communis (EDC), which is the common extensor of the fingers. These attach to the outer elbow via a common extensor tendon, which shows evidence of disruptive degenerative changes when tennis elbow is present.

When physical therapy (see more on this in Part I of this series) fails to eradicate symptoms, a variety of treatment alternatives are often utilized before surgery is considered. These include the following:

Percutaneous Needle Tenotomy (PNT)

PNT is also referred to as tendon fenestration. Ultrasound is used in this procedure to assist the clinician in repeatedly guiding the tip of a needle into the involved extensor tendon to break up scar tissue and any calcifications as well as to abrade (scrape) the bone in the region of the tendon pathology. The purpose is to induce bleeding, which is followed by clot formation and the release of growth factors. The intent of this “new” healing is to transform a chronic condition into one that is acute. Research has supported the use of PNT, which has not proved any more effective when combined with cortisone injection.

Platelet Rich Plasma Injection (PRP)

PRP entails drawing a patient’s blood, using a centrifuge to concentrate the platelets and injecting these back into the affected area. It is thought that healing is stimulated by the growth factors present in the platelets, which create reparative cells. Ultrasound imaging may be used to assist in performing this procedure.

Unlike with PNT, the recent literature on the efficacy of PRP injections for lateral extensor tendinosis is inconclusive. While some studies have found it to be of little to no benefit, others claim it may offer some promise.

Extracorporeal Shock Wave Therapy (ESWT)

This procedure uses sound waves to stimulate healing and is often used successfully to treat plantar fasciitis. However, some studies have not found it to be more successful than a placebo when used for the treatment of chronic tennis elbow.

As with PNT, the premise is to stimulate healing by creating microtrauma in the involved tissues in order to stimulate improved blood flow. However, use of ESWT for tennis elbow does not appear to be as effective.


About the author

Abby serves as the Injury Expert for CBS New York where, since 2010, her Injury Breakdown Blog examines injuries in professional sports. She also blogs on health & fitness as well as sports injuries for Huffington Post, and Recovery Physical, where her blog earned a top ten mention for physical therapy blogs in 2012 @ In a ranking of the Top 30 Healthcare Blogs for 2012, Top Masters in Healthcare also rated Abby’s blog in the top three in Physical Therapy! Abby is the founder of Fit-Screen and she welcomes your comments and questions!