But how can I have tennis elbow? I don’t even play tennis! Most people I see who have developed pain on the outer aspect of their elbow are not tennis players. A mild discomfort can develop into a throbbing ache when picking up a suitcase or gripping something tightly. The pain can worsen until sleep is affected – the umpire is then usually consulted for a review. With the right treatment, you can make a strong comeback…
A tennis elbow is a common cause of elbow pain, especially in the 30 – 50 year-old age group. The pain is usually felt on the outer aspect of the elbow and can radiate to the forearm as well. It is usually worse when trying to grip something or when lifting something heavy. A simple task like turning a doorknob may cause discomfort. It may start as a pain which can easily be ignored but can progress to a situation where there is a constant ache which interferes with sleep and daily activities.
What causes tennis elbow?
The medical term for tennis elbow is lateral epicondylitis. At the lower end of the arm (humerus) there is a bony prominence called the lateral epicondyle. This is the attachment point of the tendon of a group of muscles which control extension of the wrist. The pain from a tennis elbow originates at this point of attachment. It is thought that due to repetitive injury small micro-tears develop in the structure of the tendon. This may result in localised inflammation and eventually causes a breakdown of the normal tendon structure.
How do you treat tennis elbow?
The treatment of tennis elbow begins with simple measures like avoiding the activity which may have caused the problem in the first place. Simple rest may be the only treatment that is needed. In some instances, an anti-inflammatory may be useful. A good recommendation is to stretch out the tendon. The best way to do this is to grab the fingers (especially the index and middle fingers) on the affected side with your other hand and then bend the hand inwards at the wrist (flexion), while keeping the elbow straight. An even better stretch can be obtained if you do this manoeuvre behind your back.
A tennis elbow brace may be useful, especially in the early stages. The brace is basically a strap which is applied around the upper part of the forearm. There is a small cushion which must be positioned over the bulk of the muscle on the back of the forearm. The idea is that light pressure on this area will take tension off the tendon attachment and promote healing and resolution of symptoms.
I normally see people with established tennis elbow who have already tried some of these interventions and are still having pain. My preferred treatment at this stage is a cortisone injection into the tendon. It’s not as painful as it sounds 😉. It is done in the office and takes just a few minutes. Cortisone acts as a powerful local anti-inflammatory but the injection also causes a small amount of bleeding in the tendon, and this helps stimulate a healing response. Platelet injections and shock wave therapy can also be tried.
An injection of cortisone is usually quite effective and if the symptoms do not settle completely then a second or third injection may be required. It is not recommended to have more than two or three injections as this is unlikely to be of benefit and may, in fact, cause weakening of the tendon. For situations where conservative treatment has failed surgery is indicated.
Surgery for a tennis elbow is a simple procedure which involves removal of diseased portions of the affected tendon (debridement of the tendon). This is done as an outpatient procedure which means you do not have to spend the night in hospital. The procedure is performed through a small incision, 2 or 3 cm long. This is located over the outer aspect of the elbow.
The degenerative portion of the tendon is identified and is excised. Often there is a small bony prominence at the site of degeneration, and this is also removed. The remaining healthy tendon is repaired and the elbow is immobilised in a splint for a week or two. After this period, you may begin using your arm normally although you should avoid picking up or lifting heavy objects. It is possible to get back to work quite quickly after this procedure, but it may take up to 3 months before you have complete resolution of all your symptoms.
Tennis elbow is the commonest causes of elbow pain and can be easily treated. In most instances surgery is not needed but if it is it can be done successfully as an outpatient procedure.
Yours in good health,
MB BCh (Wits), MRCS (England), MMed (Ortho Surg), FC Orth (SA)
(011) 304 6784
About the author…
I am an orthopaedic surgeon with a special interest in sports injuries and minimally invasive (arthroscopic) surgery of the knee and shoulder. I treat patients at Waterfall Hospital in Waterfall/Midrand and Morningside Mediclinic in Sandton. Besides these, I also treat patients from other areas as well, including Rosebank, Sunninghill and Fourways.
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