Tennis Elbow (Lateral Epicondylitis) in San Antonio, TX

What Is Tennis Elbow?

Despite the name, most patients I treat for tennis elbow have never played tennis in their lives. Lateral epicondylitis is a degenerative tendinopathy of the common extensor origin — specifically the extensor carpi radialis brevis — at its attachment on the lateral epicondyle of the humerus. Repetitive gripping, wrist extension and forearm rotation create microtrauma that outpaces the tendon's capacity to repair itself, resulting in chronic pain, weakness and tenderness on the outer elbow.

It is one of the most common upper extremity conditions I see, and also one of the most undertreated. Many patients have been managing it for a year or more before seeking care — often because they have been told it will resolve on its own. It often does, eventually. But the right targeted treatment can resolve it significantly faster.

Treatment — A Staged Approach

I treat lateral epicondylitis in stages based on chronicity and response to prior treatment.

Stage 1: Activity Modification and Physical Therapy

A structured eccentric strengthening program targeting the wrist extensors has the strongest evidence base for lateral epicondylitis. Counter-force bracing and ergonomic modification reduce the provocative load. This is the foundation and most patients respond if they commit to the protocol.

Stage 2: Orthobiologic Injection

For patients who have not responded to therapy, I use platelet-rich plasma (PRP) injection — a concentration of your own growth factors injected under ultrasound guidance directly into the diseased tendon tissue. PRP has the strongest evidence of any injection therapy for lateral epicondylitis. I do not use corticosteroid injections for this condition — research consistently shows they provide short-term relief followed by higher recurrence rates and potential tendon weakening.

Stage 3: Surgery

Surgical release of the diseased tendon origin is reserved for patients who have failed 6 to 12 months of well-executed conservative care. I perform this as an open or arthroscopic procedure depending on whether concomitant intra-articular pathology is present. Outcomes after surgical release are excellent in appropriately selected patients.

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