What is it?
Otherwise known as ‘lateral epicondylitis’, tennis elbow is a painful condition affecting the outer, or lateral aspect of the elbow joint. This bony lump acts as the attachment site for a group of forearm muscles responsible for extending the wrist and fingers. These muscles converge to form a common extensor tendon.
Why does it occur?
This condition is often associated with tendon overuse and subsequent microtrauma within the tissue at the attachment point on the outer aspect of the elbow. The normal healing process is altered, and formation of fibrous tissue ensues. This painful altered tissue within the tendon repeatedly makes attempts at healing leaving further scar tissue.
What are the symptoms?
Irritation of the tendon can cause pain or tenderness around the outer surface of the elbow or more commonly at the bony attachment site. This is aggravated during certain movements, such as moving the wrist backwards against resistance or repetitive movements involving the hand or wrist such as typing.
How is it diagnosed?
A diagnosis of tennis elbow is often confirmed following a thorough history and physical examination. Further imaging such as X-ray or MRI may be utilised to rule out an alternative diagnosis.
How is it treated?
- Non-surgical treatment
Most commonly, treatment involves rest, ice and analgesics in the form of anti-inflammatory medications. Arm braces or wrist splints are also known to be effective, particularly alongside physiotherapy. This acts to reduce microtrauma at the attachment site through stretching the forearm extensors.
Steroid injections may be considered as next line in those where simple measures have not worked over a course of several months. This is successful in relieving symptoms through reducing local inflammation but when used alone there is a high chance of recurrence, therefore must be followed with a course of physiotherapy.
Platelet Rich Plasma (PRP) injections are increasingly being utilized where the initial mainstays of conservative treatment aren’t effective. The solution is extracted from the patient’s own blood and is rich in growth factors which act locally to aid tendon healing.
- Surgical treatment
This is required in rare cases following a failure of non-surgical methods and exclusion of other possible pathologies. Further imaging and potentially arthroscopy may be needed if other pathologies are suspected. If confirmed that the problems are secondary to tennis elbow, a tendon release is possible through a small 8mm incision. This will be often be closed using absorbable sutures at the time of operation and regular analgesia will be required post-operatively.
Afterwards, the heavy bandage may be removed after 5 days with the sticky dressing underneath remaining until the skin has healed at approximately 2 weeks. During this time you may move the elbow as pain allows. Physiotherapy may be required but full range of movement should be present after 2 weeks.
The course of healing can be prolonged, it is recommended that manual workers may need 6 weeks off work or sooner if doing light duties. Return to driving can be when comfortable after a few days.