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Tennis Elbow

What is Tennis elbow?

Tennis elbow is a degenerative (wear and tear) disorder involving the tendons on the outside of the elbow

Why does it happen?

It occurs due to the accumulation of wear and tear damage to the tendons on the outside of your elbow. This may be related to sporting activities such as tennis or golf however it may be secondary to work or home activities.

What are the symptoms and signs?

Pain is the main feature of tennis elbow. This is most commonly localised to the outside (lateral) aspect of the elbow. Many people with tennis elbow experience pain radiating down the back of the forearm which can extend to the wrist. Pain symptoms are usually worse on gripping or pouring activities.

What tests are required?

No further tests are usually required. There are occasions where the diagnosis is not clear and investigations such as x-rays, ultrasound or MRI scan may be requested.

What treatments are available?

Pain control – initially treatment is centred around improving the painful symptoms. This involves the rest, avoiding painful activities and the use of pain killers such as paracetamol and anti-inflammatory medications. Your doctor or pharmacist should be able to advise which ones are safe for you to take.

Tennis elbow brace – also known as an Epicondylar clasp. These are worn on the top of the forearm and should be positioned according to the instructions with the brace you have purchased

Physiotherapy – this is frequently successful in the management of tennis elbow. Most people can be cured with a structured program of stretches and exercises focussing on the tendons affected.

Injections – steroid (mixed with local anaesthetic) injections can provide excellent early pain improvement. The pain relieving effects of the steroids tend to work quickly and last for many months. Side effects of steroids are uncommon but can include them not giving any pain relieving benefit, damage to the underlying tendons and ligaments (especially if too many are administered), infection and post injection flare of symptoms (lasting 2-3 days – 5%). The steroid component of the injection can cause a local pale patch of skin (hypo pigmentation) and local loss of fat (fat atrophy).

Platelet Rich Plasma (PRP) – this is a newer treatment which involves the injection of growth factors taken from your own blood. This requires a blood sample from the unaffected arm after which the growth factors are separated – this takes 15 minutes. These factors are then injected into the area of tendon damage to stimulate a healing response in the tendon. This treatment takes longer to have an effect than steroid injections but has a lower complication rate and better success in the long term.

What happens if these treatments don’t work?

Where the previous treatments have failed to improve your symptoms sufficiently, then keyhole surgery is considered. It is important to have tried at least 6 months of physiotherapy and 1 or more injections prior embarking on this stage of treatment.

The success rate of the surgery is approximately 80%.

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