Treatment - How can I help

Tennis Elbow

Other popular names

Who does it affect?

Anyone

Why does it happen?

The cause of this condition is unclear and somewhat controversial.  It is most likely due to a problem with the muscles that insert onto the outer edge of the elbow.  When these muscles contract they cock the wrist back.

Symptoms

The lateral epicondyle is the outside bony portion of the elbow where large tendons attach to the elbow from the muscles of the forearm. These tendons can be injured, especially with repetitive motions of the forearm, such as using a manual screwdriver, cleaning windows or hitting a backhand in tennis. Tennis elbow results with inflammation of the tendons causing pain over the outside of the elbow, occasionally with warmth and swelling but always with local tenderness. The elbow maintains its full range of motion, as the inner joint is not affected, and the pain can be particularly noticed toward the end of the day.  Repeated twisting motions or activities that strain the tendon typically elicit increased pain

Diagnosis

The tender point is very well localised to the outer edge of the elbow and when examining you, I may ask you to cock your wrist back against resistance.  If this reproduces or increases your pain it is likely you have tennis elbow.

Classical tennis elbow is well known and recognised and therefore often requires no investigations.  However an x-ray may be performed to exclude arthritis and other conditions.  Occasionally an MRI may be undertaken which will clearly demonstrate the abnormality around the outside of the elbow.

Non-surgical treatment

Physiotherapy settles the majority of cases using a variety of techniques.  A tennis elbow splint can also offer benefit.

The treatment of lateral epicondylitis includes ice packs, resting the elbow, and nonsteroidal anti-inflammatory drugs (NSAID’s).  A steroid injection into the muscle tendon / bone area may improve the symptoms.  I only perform steroid injections once as further attempts may damage the overlying fat and skin causing a lightening of the skin and a hollow depression.  It is likely that I will offer you the choice of surgery at this point.

Surgical treatment

Surgery is carried out as a day case procedure usually under a general anaesthetic and takes about 15 minutes. This is performed with keyhole surgery. Sometimes it is carried out by open surgery.

Keyhole surgery is carried out through two 4mm incisions. The tendon is released from the bone from inside the elbow joint.

Open surgery is performed through a 5cm incision, the skin is incised and then the underlying fat is retracted.  At the base of the wound is the common extensor origin (the muscle/bone junction for the muscles that cock the wrist backwards).  This area is released off the bone and the underlying bone surface is nibbled to provide a healthy bed for the tendons to stick back down. 

Whichever technique is used, the skin is sutured and a bulky dressing is applied.

Post-surgery rehabilitation

You can go home soon after the operation.  The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The arm should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers and elbow from day 1. The dressing will be removed soon after your operation.  The wound is cleaned and redressed with a simple dressing.  Avoid forced gripping or lifting heavy objects for 6 weeks.  The sutures are removed at about 12 days.  You should notice an improvement in symptoms within a few weeks but the final result may take some 3-6 months.

Return to normal routine

Keep the wound dry until the stitches are out at 12 days.

Return to driving:

The hand needs to have full control of the steering wheel and left hand the gear stick.  You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.

Return to work:

Everyone has different work environments.  Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. You will be given advice on your own particular situation.

Risks

Overall over 95% are happy with the result. However complications can occur.

General risks (less than 1% each):

Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any elbow surgery from a minor procedure to a complex reconstruction).

Specific risks:

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