Tennis Elbow

The medical term for tennis elbow is lateral epicondylitis. It is a degenerative, self-limiting condition of one of the tendons at the outside (lateral side) of the elbow which causes pain. The condition usually affects people in the 40 to 65 age group. Patients often experience lateral elbow pain with gripping or picking up objects.

The main symptoms of tennis elbow are gradual and progressive. Pain is felt over the outer aspect of the elbow and can travel down the forearm. It is made worse with certain movements such as gripping objects. Most patients are able to cope with the symptoms until they start interfering with quality of life and function on a daily basis.

Tennis elbow is usually a clinical diagnosis which a specialist makes after taking a history and performing a clinical examination. An x-ray of the elbow or MRI is sometimes needed to rule out other causes of elbow pain.

Yes. Most people find that their pain improves with time but this can take up to a year.

Do avoid or modify activities that aggravate your elbow pain.

Do take simple over-the-counter painkillers.

Don’t overuse the arm – for example, gym equipment can make the pain worse.

Treatment without surgery should always be the first consideration as this is often very effective in controlling symptoms. This consists of pain killing tablets, anti-inflammatory medications and physiotherapy.

Physiotherapy has been shown in many research studies to be the best treatment for tennis elbow. A tennis elbow brace may also be effective in controlling your symptoms but it needs to be applied properly and also assessed to see if it will work.

When the symptoms of tennis elbow interfere with quality of life and daily activities it is time to consider other treatments.

Steroid injections used to be recommended in the treatment of tennis elbow but research studies suggest that whilst they may help in the short-term, the pain from tennis elbow often returns and can take longer to resolve when compared patients who never had an injection at all. Steroid injections also reduce the benefits of physiotherapy for tennis elbow. Given all of the above, Mr Wijeratna does not recommend steroid injections for tennis elbow.

Shockwave therapy can be very helpful to some patients. Mr Wijeratna has used it in patients who have symptoms that are not settling down but also are not bad enough for surgery. Shockwave therapy is a non-invasive technique where a probe is applied to the elbow and high-energy sound waves are transmitted into it. This usually needs several sessions of therapy but it is not always effective. Sometimes it can make the pain worse before it gets better.

Open tennis elbow release surgery is a good treatment for tennis elbow. The operation removes portions of the degenerate tendon and reattaches the healthy tendon back to bone. The majority of patients that have had their surgery are happy with their outcome.

Tennis elbow surgery is a day-case procedure performed under a regional anaesthetic nerve block which numbs the whole arm. The patient is awake for the duration of the procedure which enables them to recover quicker after surgery. Painkillers are prescribed for when the nerve block wears off. The patient visits their GP 10 days after surgery for a wound inspection and gentle exercises are allowed to start. Mr Wijeratna sees patients in clinic 6 weeks after surgery to check that the expected improvements are taking place and tends to discharge patients at this point.