Interventional Radiology Takes a Swing at Tennis Elbow
Tennis elbow isn’t limited to the courts; it’s a common condition that can affect a wide variety of people, from assembly workers to butchers and golfers to painters. Fortunately, the 3 percent of the population that suffers from what is technically called lateral epicondylitis may have a new treatment option. Researchers from Japan reported at the Society of Interventional Radiology’s 2019 Annual Scientific Meeting that transcatheter arterial embolization (TAE) can reduce inflammation and pain in patients who have not responded to other treatments, negating the need for invasive surgery.
What Is Tennis Elbow? Tennis elbow involves the muscles and tendons of the forearm. When the extensor carpi radialis brevis (ECRB) muscle, which helps stabilize the wrist when the elbow is straight, is overused, the tendon can develop microscopic tears where it attaches to the lateral epicondyle, a bump on the end of the upper arm bone, the humerus. Those tears can lead to inflammation and pain in the elbow, a burning sensation down the arm, and a loss of grip and arm strength.
The Growing Field of Interventional Radiology: Transcatheter arterial embolization falls under the umbrella of interventional radiology (IR), a diagnostic and therapeutic strategy that uses imaging (such as MRI scans, ultrasound, and X-rays) to perform minimally invasive procedures. It can be used to treat a wide variety of conditions—such as certain cancers, uterine fibroids, deep vein thrombosis, and pleural effusion—with less risk and shorter downtime. It requires less sedation and often can be a same‑day procedure.
What TAE Does. Many people fail to find relief with conservative treatments. In this prospective study, 52 such patients underwent TAE with local anesthesia. To perform the procedure, the study authors inserted a catheter into the radial artery in the wrist and threaded it to the elbow. Once it was in place, they sent imipenem/cilastatin sodium through the catheter to block, or embolize, the inflamed blood vessels.
The research team then followed the patients for up to four years. In that time, the patients reported statistically significant reductions in pain, without the need for physical therapy. Imaging in a subset of patients showed improvement in swelling and tears in the tendon. The researchers concluded that TAE could be an effective treatment for tennis elbow.
Traditional Treatment. TAE would not be the first line of treatment but rather reserved for difficult-to-treat cases in which conservative treatments failed. The first line of treatment for tennis elbow is rest and the use of nonsteroidal anti-inflammatory medicines for several weeks. A physician may suggest wrist-stretching exercises or order physical therapy as well. An over-the-counter forearm brace can take pressure off of the muscles and tendons. If those measures don’t work, some patients have steroid injections to reduce the inflammation. If that also doesn’t help, and symptoms persist for six months to a year, physicians often begin to suggest surgery. This is where TAE may one day come in—as a safer, simpler alternative to invasive surgery. DM
THE VIEW FROM DUKE: More Evidence Is Needed
“Tennis elbow, or lateral epicondylitis, is an overuse injury that affects 3% of the population. Despite its prevalence, only 4 to 11% of patients with the condition ultimately require surgery. As the problem is primarily one of a decreased blood supply to the overused tendon, it is counterintuitive that an embolization procedure to block the blood flow to the tendon would be successful. This procedure is not well known in the orthopedic literature. While the mainstay of therapy is nonoperative, all surgical interventions are aimed at removing the degenerative tendon and/or restoring the blood flow to the diseased tendon. More evidence is needed to establish this intervention as efficacious in the treatment of tennis elbow.”
—Marc Richard, MD, Associate Professor of Orthopedic Surgery, Duke University School of Medicine
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