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Tennis Elbow

What is it?

Tennis elbow (or lateral epicondylosis) is a degenerative condition affecting the insertion of the tendons into the bone on the outside part of the elbow.  These tendons are connected to the muscles that enable us to lift (extend) both the wrist and fingers.  The condition affects 1-3% of the population and is more common in middle age (i.e. 40-50 years of age).  It was orginally recognized commonly in Tennis players, hence the name, but the vast majority of cases are seen within the general population.

Tennis elbow is thought to result from repetitive small tears to the tendon insertion causing characteristic pain and tenderness over the lateral part of the elbow with activities such as gripping and lifting.  The pain can radiate down the forearm.

Diagnosis

Tennis elbow can usually be diagnosed reliably from the history of your symptoms and a detailed examination. An X-ray of your elbow may be arranged to exclude other conditions such as arthritis.  An MRI scan may also be requested to assess the soft tissues around the elbow in greater detail.

Treatment

There are many treatment options available to treat the symptoms of Tennis Elbow and often a combination of these is required.  Your surgeon will advise you after having assessed the severity of your symptoms:

Resting from activities that exacerbate the pain will often help to improve symptoms. Poor sporting technique can worsen symptoms.  Advice regarding this from a sports coach or physiotherapist can be helpful.  A short course (up to six weeks) of anti-inflammatory medication taken regularly has been shown to improve symptoms, albeit in the short term.  Excellent benefit can be obtained from physiotherapy . The physiotherapist will use a combination of manual techniques, ultrasound and strengthening exercises (eccentric-based regimen). The use of splints/clasps and acupuncture may also derive benefit for some patients.

Injections

 

Steroid injections

Injections for tennis elbow has been a topic of some discussion over the past few years. Traditionally injection of local anaesthetic and corticosteroid has been used with good benefit.  Research has emerged suggesting that whilst these injections can improve symptoms for a while, they may make the pain come back worse than ever.  We would therefore suggest that these injection be used sparingly now in the treatment of tennis elbow.

Injection of blood products

The use of blood and blood derived products as an injection treatment for tennis elbow has been used for many years.  Recent high profile sporting examples have focused media attention on this form of treatment.  Blood taken from you ( ie autologous blood) can be injected into the area of tennis elbow to provide benefit from symptoms.  It is thought to deliver healing hormones directly to the area of tendon damage, promoting healing. 

Platelet rich plasma (PRP) is a concentrated portion of your own blood, (hence having a higher proportion of the healing hormones) that is also available now to treat Tennis Elbow.  This is demonstrating promising results.

Shockwave therapy

This is a non-invasive technique which uses high energy focused sound waves onto the area of injury.  This is thought to promote healing of the injured tendon insertion. 

Surgery

Surgery for tennis elbow remains the gold standard treatment for symptoms that have not resolved with the use of the above treatment options.  Thus, only a small amount of patients will require surgery.  Surgery is performed under either a General  or Regional Anaesthetic (i.e. numbing the whole arm).  Surgery is performed as a Day Case procedure (you go home on the same day).  An incision is made over the area of tenderness and the abnormal part of the tendon is excised.  This is successful in 80% of patients.

Post-operative care

The wound is closed with absorbable sutures.  A dressing and bandage are applied.  Sometimes a Plaster of Paris (POP) may be applied for a short period of time.  It is very important that the tendon is not overloaded in the first 6-12 weeks following surgery. You will therefore be referred to the Physiotherapist to begin the very important rehabilitation process.