Understanding Tennis Elbow: Symptoms, Diagnosis and Treatment

With The Wimbledon Championships over, Mr Vish Patel takes the opportunity to delve into tennis elbow, from symptoms to treatment. But contrary to what the name might suggest, it doesn’t just affect those on the courts.

Tennis elbow is also known as Lateral Epicondylitis. This is a condition which causes pain on the outer side of your elbow due to degeneration (wear and tear) and inflammation of the area where the tendons of your forearm muscles attach to the elbow. The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury.

Why?

Tennis elbow is an overuse injury due to repetitive over loading of your forearm muscle that involves bending your wrist back and extending your fingers (Extensor Carpi Radialis Brevis). These muscles attach to the outer bony edge of your elbow called the epicondyle through tissue called tendons. It is degeneration and inflammation of these tendons from repetitive loading/ overuse that leads to pain.

Who?

Despite what the name suggests tennis elbow does not exclusively occur in tennis players. Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. It is thought that the repetitive manual tasks and lifting pre-disposes to tennis elbow in these occupations.

DIAGNOSIS:

Tennis elbow can be diagnosed from your symptoms and with certain tests that reproduce your pain; specifically pain on the outer part of your elbow and weak grip strength. The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or using a screwdriver.

Examining the elbow involved pressing near the lateral epicondyle (outer bony edge of the elbow) where the ECRB tendon (main tendon affected) inserts and testing the strength of your wrist and finger extension (keeping them straight against resistance). Both of these will cause pain.

There are of course other problems such osteoarthritis, ligament damage and nerve inflammation that can cause similar symptoms and these may have to be investigated with an X ray and/ or MRI scan of your elbow.

TREATMENT:

• Tennis Elbow in 90% of cases resolves over time (self-limiting). However, this usually takes on average 6 -12 months to resolve. The first line of treatment is to reduce overloading your forearm and to wear a Tennis Elbow brace/ clasp for a period of 3 months (A tennis elbow brace can be bought online or from any health care shop).
• It is also important to seek advice on your sporting activity technique or work supervisor to make adjustments/ corrections to help reduce overloading (please see useful external links).
• Physiotherapy which concentrates on stretching and gradual strengthening program helps with recovery. This is the first line of treatment.
• Cortisone/ Steroid injections help minimise pain by reducing inflammation. Cortisone injections have the most impact within 6-8 weeks of getting symptoms. However, there are reports to suggest steroid injections can make symptoms worse at 1 year in some patients who continue to have symptoms. I do not recommend repeated cortisone injections as this can potentially weaken the tendon.
• PRP (Platelet Rich Plasma) is used in the treatment of tennis elbow and the evidence is growing about its effectiveness. PRP treatment aims to regenerate the damaged tissues which lead to tennis elbow by using concentrated bloods cells known as platelets which are important in healing and clotting. A UK study has shown PRP is effective in 70% of patient avoiding the need for surgery but other studies have not shown any benefit over physiotherapy or steroid injections.
• Tennis Elbow Surgery is considered when all other non- invasive treatments have failed. Surgery involves releasing the ERCB tendon which is tendinopathic (wear and tear) or repairing the tendon if it has fully torn. The aim of tennis elbow surgery is to remove the diseased tissue around the outer elbow, improve blood supply to the area, and alleviate your symptoms.

It is important to remember surgery is reserved for resistance cases after non-operative treatment options have failed to improve your pain. Enough time must be given to allow your elbow to ‘self – resolve’ or heal itself naturally. 90% of patients settle down without the need to go onto have surgery within about 6 months. Surgery is considered a last resort for the treatment of persistent pain. The success rate of surgery for relieving tennis elbow pain is 85-90%.

About Mr Vish Patel

Mr Patel is a triple fellowship-trained orthopaedic surgeon specialising in shoulder and elbow/ upper limb surgery. To find out more or to book an appointment with him click here.