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Short Summary
Main recommendation: For tennis elbow (lateral epicondylitis) that has not responded to conservative care such as rest, ice, and NSAIDs, elbow artery embolization (EAE) can be considered as a minimally invasive, outpatient option that targets the inflammation driving the pain. The speaker, an interventional radiologist at UCLA, presents EAE as a newer alternative to cortisone injections and surgery, supported by a small Japanese study and a single case.
Key Points
- Tennis elbow is an overuse injury involving micro-tears in the tendons attaching to the outer elbow; the pain comes from the inflammatory healing response, not the tears alone.
- Common treatments are staged: rest and ice first, then ibuprofen or naproxen (helpful but often only temporary), then cortisone shots (relief lasting weeks to months, often recurring), and surgery as the most invasive option.
- The speaker states surgery is about 80 percent effective but requires months of recovery, often in a brace with the arm largely immobilized.
- EAE is presented by the speaker as an angiogram-guided procedure aimed at reducing the inflammatory "haze" visible on imaging, which he says decreases pain.
- Evidence cited is a 2017 University of Tokyo study of 24 patients (mean age 52) who had failed conservative treatments; according to the speaker, pain and dysfunction scores returned near normal within months and stayed there through two years of follow-up, per the cited study.
- Pickleball, tennis, manual labor (such as hammering), keyboard use, and golf are named as common triggers.
Details Worth Noting
- Concrete instructions: Tennis elbow is typically diagnosed by localized tenderness on the outer elbow, pain when extending the wrist backward, and pain when flexing the wrist forward. Conservative care first means rest the elbow and apply ice; if the activity must continue, ibuprofen or naproxen may be tried. Cortisone injections are a further option. If these fail, the speaker says EAE can be considered; surgery is the remaining option. The transcript does not give dosages, frequencies, or durations for the medications.
- Procedure details (as described): It takes about 20 to 30 minutes, can be done under light sedation or only local anesthetic, and patients go home about half an hour later with a wristband. A numbing agent is placed at the wrist, a very small catheter (about the size of spaghetti) is threaded through the radial artery up to the elbow, and contrast dye is injected to map the arteries feeding the painful area. Two to three drops of microscopic plastic particles, smaller than grains of sand, are then injected to slow flow in the inflamed branch. The goal is to reduce the inflammation, not fully block the vessel.
- Case example: A 78-year-old former tennis player, now a pickleball player, rated his pain 8/10 and had a PRTEE pain score of 26/50 (typical scores are about 0 to 1). At one and six months his pain was reported as 0/10, and he returned to racket sports at full capacity.
- Study caveats: The Tokyo study had only 24 patients, all with long-standing symptoms, and the presentation does not discuss long-term outcomes beyond two years or compare EAE directly against surgery in a controlled way.
- The speaker positions EAE as something to consider after conservative management fails, not as a first-line treatment.
Bottom Line
For tennis elbow that persists after rest, ice, medication, and possibly cortisone, EAE is a newer, low-risk outpatient option worth discussing with a specialist, though the supporting evidence presented is limited to a small study and a single case.
