An in-depth discussion on tennis elbow

Tennis elbow is an extremely prevalent condition, resulting in significant daily pain. Here to provide an in-depth discussion about the condition is consultant orthopaedic surgeon Mr Nick Ferran.

What is tennis elbow?

Many patients struggle with tennis elbow, and figuring out the best way to treat it can be tricky. Tennis elbow occurs when one of the tendons on the outside of your elbow wears down and causes pain. The medical term for the condition is lateral epicondylitis. It occurs most commonly in people aged between 40 and 65 years old.

People with tennis elbow often feel pain on the outer side of their elbow when they grab or lift things. In severe cases, the pain might even bother them when they're not doing anything. To get the right treatment for tennis elbow, it's important to get the right diagnosis.

What causes tennis elbow?

The majority of tennis elbow cases don't have a specific cause. The ECRB (extensor carpi radialis brevis) tendon naturally wears down with age, and as it degenerates, pain fibres and extra blood vessels grow into the affected tissue, causing pain. In certain instances, the condition might be sparked by repetitive strain injury due to excessive stress on the wrist's extensor muscles, which connect to the outer part of the elbow. This strain or repetitive injury can result from work or sports activities, but sometimes there is no identifiable cause. no obvious reason for it.

How is tennis elbow diagnosed?

In the majority of instances, diagnosing tennis elbow is clinical, meaning a thorough history, clinical examination, and occasionally an X-ray are sufficient. If the information gathered, symptoms, or examination results are unclear, we may do an MRI scan to confirm a tennis elbow diagnosis or eliminate other potential causes of lateral elbow pain. Additionally, an MRI may be used for cases where the pain persists despite treatment to rule out alternative sources of elbow discomfort.

What is the number 1 treatment for tennis elbow?

Tennis elbow treatment can be challenging, but understanding the condition is key, and collaboration with healthcare professionals is crucial for effective rehabilitation. The natural course of tennis elbow typically sees improvement within a year, with symptoms being rare after the age of 65.

Mild cases may respond to over-the-counter pain relievers and avoidance of aggravating activities. For severe cases, physiotherapy, emphasising exercise to strengthen wrist extensor muscles, is the primary and most effective treatment, often taking at least three weeks for noticeable benefits.

In situations where unavoidable repetitive stress occurs, modified physiotherapy may involve regular breaks and specific exercises during rest intervals to prepare muscles for continued activity.

Are tennis elbow splints useful?

For individuals with a recurring triggering factor, such as work or sports, contributing to their tennis elbow, a tennis elbow splint may prove beneficial. In my clinic, we will assess the appropriateness of this intervention during your clinic evaluation. Tennis elbow splints function by relieving the ECRB tendon at the elbow, facilitating the healing process.

Several key considerations apply to the use of a tennis elbow splint:

• Ensure that the splint includes a pad and is applied correctly.
• Utilise the splint exclusively during activities that exacerbate the condition; avoid wearing it continuously, during periods of rest, or while sleeping at night.
• Refrain from using the splint during physiotherapy exercises.

Should I have a steroid injection for tennis elbow?

While steroid injections were once a common treatment for tennis elbow, in recent years there have been multiple research studies which indicate their adverse effects on the condition. Current evidence suggests that while a steroid injection may initially alleviate pain for approximately six weeks, patients who undergo this treatment for tennis elbow often experience a recurrence of symptoms after a year. Moreover, the recurrent pain tends to be more severe than in individuals who receive no treatment.

Research also indicates that individuals who undergo both steroid injections and physiotherapy fare worse than those who opt for physiotherapy alone. Steroid injections appear to diminish the positive outcomes of physiotherapy in treating tennis elbow.

As a result of these findings, we neither provide nor endorse steroid injections for tennis elbow, despite their regular use in addressing shoulder conditions where research supports their efficacy.

What is the surgical management for tennis elbow?

Provided that the patient receives appropriate physiotherapy, surgery is not usually essential. However, in some cases, patients may not respond to physiotherapy, often due to an unavoidable aggravating trigger. For recurrent or stubborn cases of tennis elbow, an MRI scan is typically performed to rule out potential causes of internal elbow pain. Following this, an arthroscopic tennis elbow release is recommended, involving a minimally invasive procedure to remove the affected ECRB tendon tissue. This keyhole operation can also address any other sources of joint pain simultaneously.

We recommend having key-hole elbow surgery while you are awake, under regional anaesthesia, in order to mitigate the risks associated with general anaesthesia.

What is the recovery from tennis elbow surgery?

Typically, arthroscopic tennis elbow release is performed as a day-case procedure, with the patient awake under regional anaesthesia. Post-surgery movement begins the day after with support from physiotherapists. Patients typically wear a temporary sling for 24 hours, followed by a bulky bandage for 48 hours, resuming full movement after bandage removal.

Sutures are commonly removed within two weeks, and by approximately three months, most patients have regained a full level of activity, often leading to discharge from the clinic.

If you would like to book a consultation with Mr Ferran, do not hesitate to do so by visiting his Top Doctors profile today.