Ultrasound-Guided Release of Lateral Epicondylitis (Tennis Elbow) Under Local Anaesthesia
Lateral epicondylitis, also known as tennis elbow, is a common cause of pain on the outer side of the elbow. It is most often associated with overuse and structural changes in the common extensor tendon of the wrist and fingers at its attachment to the lateral epicondyle of the humerus. Changes particularly often affect the extensor carpi radialis brevis (ECRB) tendon.
Although the term “epicondylitis” is used, in long-standing cases the condition is more commonly associated with tendinopathy, or degenerative changes in the tendon, rather than acute inflammation alone.
Typical symptoms include pain on the outer side of the elbow that becomes more pronounced when gripping objects, lifting weights, extending the wrist or repeatedly loading the arm.
If appropriate conservative treatment has not provided sufficient improvement, one treatment option is minimally invasive release of lateral epicondylitis under ultrasound guidance and local anaesthesia. Ultrasound allows the physician to visualise the tendon and fascial treatment area, as well as nearby anatomical structures, in real time during the procedure.
What is lateral epicondylitis or tennis elbow?
Lateral epicondylitis is an overuse-related tendinopathy affecting the attachment site of the wrist and finger extensor tendons on the outer side of the elbow.
Tendons connect the muscles of the forearm to bone and are involved in movements of the wrist and fingers. Repetitive or prolonged loading can lead to structural changes in the tendon, causing pain and reduced arm function.
The term “tennis elbow” does not mean that the condition occurs only in tennis players. It can develop in people with many different types of everyday, occupational or sporting activity.
What are the symptoms of lateral epicondylitis?
The most characteristic symptom is pain on the outer side of the elbow.
Possible symptoms include:
pain or tenderness in the lateral epicondyle area;
pain that may radiate into the forearm;
pain when gripping or holding objects;
discomfort when lifting a cup, bag or other objects;
pain when extending the wrist against resistance;
pain during repetitive arm movements;
reduced grip strength;
difficulty performing work or sporting activities that require active loading of the wrist and forearm.
Symptoms may develop gradually and persist for several months.
What causes lateral epicondylitis?
It is not always possible to identify one specific cause of the condition. Lateral epicondylitis may be associated with repetitive or unusual loading of the wrist extensor muscles and their tendons.
Factors that may contribute to symptoms include:
repetitive gripping movements;
frequent wrist extension against resistance;
working with tools;
intensive use of the arms at work or in everyday life;
racquet sports;
strength training and other physical activities;
sudden or unusual increases in physical load.
Lateral epicondylitis can also occur in people whose work or daily activities do not involve pronounced repetitive arm loading, so a particular occupation or sport should not be regarded as the sole cause of the condition.
How is lateral epicondylitis diagnosed?
The physician usually makes the diagnosis by assessing the patient’s symptoms and performing a clinical examination of the elbow and forearm.
The physician may assess:
the location of pain;
the duration and nature of symptoms;
elbow and wrist movements;
tenderness around the lateral epicondyle;
pain when extending the wrist or fingers against resistance;
grip strength;
elbow and arm function.
It is also important to exclude other possible causes of pain, such as elbow joint disorders, nerve irritation or pain radiating from the cervical spine.
Ultrasound in the diagnosis of lateral epicondylitis
If necessary, a musculoskeletal ultrasound examination is performed.
Ultrasound can be used to assess:
the structure of the common extensor tendon;
tendon thickening;
signs of tendinopathy;
partial tendon injuries;
calcifications or other structural changes;
the tendon attachment area at the lateral epicondyle;
surrounding ligaments, nerves and other anatomical structures.
Ultrasound is particularly important when planning a minimally invasive procedure because it allows the physician to precisely locate the affected tissue and monitor the position of the instrument in real time.
In clinical studies, ultrasound-guided minimally invasive procedures for chronic common extensor tendinopathy have been performed on an outpatient basis under local anaesthesia.
How is lateral epicondylitis treated?
For most patients, treatment begins with non-surgical methods. The treatment plan is determined individually, taking into account the duration of symptoms, the nature of the physical load and the condition of the tendon.
Conservative treatment
The physician may recommend:
temporarily reducing or modifying activities that provoke symptoms;
gradually dosed physical loading;
physiotherapy;
specific exercises for the forearm muscles and tendons;
adapting work and sports technique;
an orthosis or epicondylitis brace;
anti-inflammatory or pain-relieving treatment, if appropriate for the patient;
shockwave therapy;
in selected cases, injection therapy.
At the Veselības centrs 4 Diagnostikas centrs, ultrasound-guided injection methods, such as PRP therapy, are also used in the treatment of musculoskeletal problems, including epicondylitis. Suitability for a specific method is determined by the physician after an individual assessment.
Minimally Invasive Ultrasound-Guided Release of Lateral Epicondylitis
If pain persists despite appropriate conservative treatment and examinations reveal chronic changes in the common extensor tendon or fascial area, a minimally invasive release procedure may be considered.
Ultrasound-guided release of lateral epicondylitis is a minimally invasive procedure in which the physician treats the pathologically altered extensor tendon and/or fascial area under ultrasound guidance in order to reduce tissue tension and symptoms associated with tendinopathy.
Medical literature describes both ultrasound-guided percutaneous tenotomy and fasciotomy techniques for the treatment of chronic lateral epicondylitis. These procedures can be performed under local anaesthesia while visualising the treated tissues and nearby anatomical structures.
What is released during the procedure?
In lateral epicondylitis, the problem is usually associated with the common wrist extensor tendon complex and, in particular, with the structures of the extensor carpi radialis brevis muscle and tendon.
Depending on the patient’s anatomy, ultrasound findings and the technique used, the pathologically altered tissues are released using a minimally invasive approach.
The aim of the procedure is not to completely divide a normal tendon, but to specifically treat the affected area. The exact extent of the procedure is determined individually by the physician.
How is the procedure performed?
The procedure is performed under local anaesthesia on an outpatient basis.
The physician:
Assesses elbow and arm function.
Uses ultrasound to examine the common extensor tendon and surrounding structures in detail.
Identifies the treatment area and the safest instrument entry point.
Administers local anaesthesia.
Introduces a specialised instrument through a small access point under ultrasound guidance.
Releases the pathologically altered tendon or fascial area according to the selected technique.
Assesses the treated area under ultrasound guidance.
During the procedure, ultrasound allows continuous monitoring of the position of the instrument in relation to the tendon, nerves, ligaments and other anatomical structures.
What are the advantages of an ultrasound-guided procedure?
Compared with more extensive open surgery, a minimally invasive ultrasound-guided approach may offer several advantages:
a small access point to the treatment area;
real-time visualisation of the treated structure;
the procedure is performed under local anaesthesia;
precise control of instrument positioning;
less soft-tissue trauma;
a large surgical wound is usually not required;
potentially faster return to light everyday activities.
Ultrasound-guided percutaneous tenotomy and fasciotomy are described in the medical literature as minimally invasive alternatives for selected patients with chronic lateral epicondylitis that has not responded sufficiently to conservative therapy.
However, the outcome of the procedure and recovery time may vary from patient to patient.
Who may be suitable for the procedure?
Ultrasound-guided release of lateral epicondylitis may be considered in patients who:
have been diagnosed with chronic lateral epicondylitis or common extensor tendinopathy;
have persistent pain;
have symptoms that interfere with work, sport or everyday activities;
have reduced grip strength;
have not achieved sufficient improvement with conservative treatment;
have tendon or fascial changes on ultrasound that are suitable for the procedure;
have anatomy that allows a minimally invasive approach.
If a significant tendon tear, joint pathology, nerve injury or another cause of pain is identified, a different treatment strategy may be required.
A physician’s consultation and individual assessment are required before the procedure.
Is ultrasound-guided release of lateral epicondylitis an operation?
It is a minimally invasive procedure in which a specialised instrument is used to treat the pathologically altered tendon or fascial area.
Unlike conventional open surgery, the procedure is performed through a very small access point under ultrasound guidance and local anaesthesia.
Recovery after the procedure
After the procedure, the treated area may have:
tenderness;
mild swelling;
bruising;
temporarily increased pain;
discomfort when moving or loading the arm.
The load on the arm usually needs to be increased gradually. The recovery plan may include physiotherapy and gradual loading of the tendon.
Return to work and sport depends on how the patient feels, the nature of their work, the type of sport and the condition of the treated tendon.
Because structural recovery of the tendon takes time, symptom relief is not always immediate.
Possible risks
As with any invasive procedure, ultrasound-guided release of lateral epicondylitis may involve risks such as:
bleeding or bruising;
swelling;
pain at the procedure site;
infection;
incomplete symptom relief;
recurrence of symptoms;
prolonged tenderness or stiffness;
injury to a tendon, ligament, nerve or other surrounding structure.
Ultrasound guidance helps the physician navigate anatomical structures accurately, but it cannot completely eliminate the possibility of complications.
When should you see a physician?
A specialist consultation is recommended if:
pain on the outer side of the elbow persists for several weeks;
the pain becomes more pronounced;
gripping or lifting objects becomes painful;
grip strength decreases;
pain interferes with work or sport;
conservative treatment has not provided sufficient improvement;
pain radiates into the forearm or tingling, numbness or pronounced weakness of the arm develops.
Timely diagnosis helps determine whether the symptoms are caused by lateral epicondylitis or another problem affecting the elbow or forearm.
Ultrasound-Guided Release of Lateral Epicondylitis Under Local Anaesthesia in Riga
Ultrasound-guided release of lateral epicondylitis under local anaesthesia is available at the Veselības centrs 4 Diagnostikas centrs, Grebenščikova iela 1, Riga.
The procedure is performed by Dr Matīss Mežals – Algologist, Physical and Rehabilitation Medicine Physician, Ultrasound Specialist.
A physician’s consultation is required before the procedure to confirm the diagnosis and assess the most appropriate treatment method.
