• Diagnosis
  • Treatment
  • Rehabilitation

Tennis Elbow

This condition is also known as lateral epicondylitis or more generally as lateral elbow pain. The lateral part of your elbow is the outer part, furthest away from your body.

Lateral elbow pain is extremely common amongst sports people and manual workers. The most common cause is overuse related to excessive wrist extension.

In tennis elbow the place where the muscles attach to the bone on the outside of the elbow becomes tender and painful. This part of bone is called the lateral epicondyle. The condition can start gradually or after sudden forceful use of the arm, often with a feeling of something ‘tearing’ at the elbow.

There will be damage to the fibres of the muscle below the painful area. As those muscles are used to for almost all hand activities, it is very difficult to rest the damaged part completely. A cycle of damage and inadequate healing can occur which aggravates the symptoms. Particular activities may become almost impossible to perform. The pain and discomfort often spreads down the forearm towards the hand.

There is a very similar condition which affects the medial (inner) side of the elbow. This is called Golfer's Elbow or Medial Epicondylitis. The treatment is very similar to Tennis Elbow.

Symptoms

Patients typically experience pain radiating from the lateral epicondyle into the forearm muscles. Occasionally the pain is more localised but the onset may be sudden or gradual. The severity of pain can range from minor to incapacitating.

Pain may radiate into the forearm due to a trapped nerve or irritation of other nerves. If pain is related to activity level, aggravated by certain movements, usually wrist extension or gripping, it is more likely to be of a mechanical origin rather than neural (nerves).

The outer muscles are affected in Tennis Elbow and the tip of the lateral epicondyle becomes tender to touch, whereas, with Golfer’s Elbow the symptoms are similar but on the other side of the elbow.

If pain is persistent, unpredictable or related to posture, referred pain should be considered. Associated sensory symptoms such as pins and needles may indicate a neural problem.

This condition is common in middle aged people and not just in people who play golf or racquet sports.

Investigation

Patients are examined by testing elbow movements and examining muscles and soft tissues. In longstanding or complex cases xrays, ultrasound or even an MRI scan may prove useful.

 

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Tennis Elbow

The vast majority of patients with this condition find that it settles down over time. This can take up to 18 months. During this time various strategies are available to try and relieve the symptoms and help the patient return to normal life. These include activity modification, painkillers (rubbed in or taken orally), a supportive brace worn around the top of the forearm (tennis elbow brace) and stretching exercises.

Physiotherapy and an elbow clasp can relieve the symptoms. The clasp is a padded strap worn just below the elbow. It squeezes the muscles before they attach to the epicondyles so reducing the muscle pull on the bone during activity

Another option is a steroid injection into the tender area – also known as cortisone injections. This can produce a dramatic reduction in symptoms but is not always effective and will wear off over time. There is some evidence that there may well be a rebound, or even an increase, in symptoms when the steroids wear off.

There is no evidence that steroid injections shorten the time to recovery in this condition. A steroid injection might help the patient through a bad phase however and the injection can be repeated if it works well.

Many other treatments have been tried for this condition but none have been shown to improve the outcome compared with just waiting for the body to resolve the problem. There have been some encouraging early results with the use of injections derived from the patient's own blood (platelet rich plasma injections) but this treatment is not proven as yet.

In a very small number of patients who experience severe symptoms for a prolonged period of time surgery can be considered. The operation is carried out as a day case procedure usually under a general anaesthetic. The damaged muscle is removed and the bone insertion point freshened to try and improve its ability to heal.

About 70% of patients experience some relief of their symptoms with this operation but it is rare for the problem to resolve completely. 30% are not improved and a very small number of patients feel worse after surgery. Surgery is therefore not recommended except as a last resort.

Tennis Elbow

Immediately after the operation there will be a small adhesive dressing on the wound and a padded bandage around the elbow. Patients will be encouraged to move the hand, wrist and shoulder immediately and to keep the hand and arm elevated for a week or so after the surgery to avoid swelling.

After three days the padded dressing can be removed but the wound still needs to be kept clean and dry. At this stage gentle movement of the elbow is encouraged to regain full mobility but patients should avoid heavy lifting for six weeks after the operation to allow the tissues to heal.

After six weeks most patients are back to normal activities and strengthening the elbow but it may take up to three months for the residual discomfort in the scar and elbow to settle.