Tennis Elbow
What is Tennis Elbow?
Tennis elbow, also known as lateral epicondylitis, is a degenerative condition affecting the tendons that insert into the bony prominence on the outside (lateral) aspect of the elbow.
What Causes Tennis Elbow?
Tennis elbow is caused by an imbalance in the normal tissue turn-over in the extensor tendons that arise from the lateral epicondyle on the outer side of the elbow. Extensor Carpi Radialis (ECRB) tendon is most commonly affected, and it is usually precipitated by repetitive strain. This tendon is involved in extending the wrist joint and is also active when gripping with the wrist extended (as in tennis). Any activity that twists and extends the wrist can lead to tennis elbow It is common in racquet sports, throwing activities, and occupations involving repetitive arm use.
Clinical Presentation
The first sign of tennis elbow is usually pain and tenderness when pressure is applied to the outside of the elbow. Pain with tennis elbow is typically localised over the bony bump on the outside of the elbow (lateral epicondyle) and may extend down to the hand. If left untreated, a dull constant pain or sharp shooting pain can be felt. Swelling may be present. Other symptoms include:
- Pain when the wrist or hand is straightened (wrist extension)
- Pain felt when lifting a heavy object
- Pain when gripping, making a fist or shaking hands
- Shooting pains from the elbow down to the forearm or up into the upper arm
Sometimes other conditions that are not linked to tennis elbow can cause pain in the elbow. For example, arthritis of the elbow, a pinched nerve in the neck, shoulder impingement and carpal tunnel syndrome.
Diagnosis
The diagnosis of Tennis Elbow is clinical. This area is usually very tender to touch. Rest usually relieves the pain. Any occupational risk factors, and recreational sports participation.
Conditions mimicking tennis elbow include:
- Elbow arthritis
- Pinched nerve in the neck or elbow
- Shoulder impingement syndrome
- Carpal Tunnel Syndrome.
Investigations (if required)
The following investigations may be used to rule out any other pathology:
- X-Ray
To rule out arthritis or bone abnormalities. - MRI
To evaluate soft tissue damage - Electromyography (EMG)
To checks for nerve entrapment.
Treatment
Approximately 80-95% of patients have success with nonsurgical treatment.
- Rest, activity modification
The first step toward recovery is to give your arm proper rest. This means that you will have to stop participation in sports or heavy work activities for several weeks. Drugs like aspirin or ibuprofen reduce pain and swelling. - Non-steroidal anti-inflammatory medications
Non-steroidal anti-inflammatory drugs (NSAIDs) e.g. ibuprofen, to reduce pain and swelling. - Equipment check
Proper racquet and ergonomic adjustments at work place. - Physiotherapy
Specific exercises are helpful for strengthening the muscles of the forearm. Eccentric exercises programme is helpful. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing. - Brace
Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons. This needs to be used for all the time that patient is awake, especially remembering weekends. - Blood Products/Platelet Rich Plasma (PRP) injections have shown promising results and have become more commonly used. I have suffered from tennis elbow pain and got excellent results from the PRP Injection
and have recovered completely. - Steroid Injections
These have been used for a number of years and have shown to provide pain relief for short period of time, but there are some concerns that it makes the condition worse over longer period. I do not recommend steroids. - Shock Wave Therapy
Shock wave therapy sends sound waves to the elbow. These sound waves create “microtrauma” that promote the body’s natural healing processes. Shock wave therapy has shown to be beneficial in cases non responding to other forms of non operative treatment. - Surgery
This is reserved for the resistant and disabling tennis elbow. This may be done using
– Open Surgery: Traditional approach to debride and repair the tendon.
– Arthroscopic Surgery: Minimally invasive technique for tendon release and debridement.
Read more about surgery for Tennis Elbow.
Treatment Rationale
Tennis Elbow can significantly impact arm function, especially in tasks requiring gripping, repeated use and control. Early intervention with a healthcare professional can guide patients in selecting the best treatment option for optimal recovery and function. I believe and practice ‘Shared Decision Making’ and the final decision is made with patient, understanding the pros and cons of the options.