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. Tennis elbow occurs if the joint is overused, or subjected on a frequent basis to a specific repetitive action.
Why does it occur?
This condition is often associated with the overuse of tendons, and the subsequent microtrauma within the tissue where it attaches to the outer aspect of the elbow. The normal healing process is interrupted, and fibrous tissue begins to form; the altered tissue within the tendon makes repeated attempts to heal, leaving further painful 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 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 taking of your medical history, and a physical examination. Further imaging such as s-rays or MRI scans may also be used to rule out an alternative diagnosis.
How is it treated?
Most commonly, treatment involves rest, ice and painkillers in the form of anti-inflammatory medications. Arm braces or wrist splints are also known to be effective, particularly alongside physiotherapy. The brace or split acts to reduce microtrauma at the attachment site by stretching the forearm extensors. Steroid injections may be considered as they are successful in relieving symptoms by reducing local inflammation. They would normally be followed by a course of physiotherapy to reduce the chance of recurrence.
Platelet Rich Plasma (PRP) injections are being used more and more where conservative treatment is not effective. A solution is extracted from the patient’s own blood, rich in growth factors which aid tendon healing.
Shoulder surgery is rare, and is required if other treatments are ineffective and other causes of pain have been ruled out. Further imaging (x-rays and scans), and potentially arthroscopy (keyhole surgery) to determine the precise issue. If there are problems with the joint that are secondary to tennis elbow, a tendon release procedure is possible through a 8mm incision. This will often be closed using absorbable stitches, then bandaged, and painkillers will need to be taken for a while afterwards.
The bandage may be removed after 5 days, but the sticky dressing underneath stays in place for at least the next 2 weeks while the skin heals. The elbow can be used, as far as pain permits, during this recovery time, and physiotherapy may be required. Full range of movement should be possible again after 2 weeks, but in some cases can take longer. Manual workers may need up to 6 weeks off work, and patients generally return to driving as soon as it feels comfortable to do so.
The One Orthopaedics team specialists
Consultant Orthopaedic Specialist FRCS (Tr & Orth)