This is probably the commonest condition that is seen in the elbow. It is characterised by pain over the bony prominence on the outside of the elbow and is made worse by use of the arm, particularly in repetitive tasks, but even simple tasks such as picking up a mug or another item off a table often frequently aggravates the pain. It is generally caused by repetitive activities although in some cases can be caused by direct injury or blow to the outside aspect of the elbow. The underlying injury is damage to the attachment of the tendons to the bone on the outer aspect of the elbow. The group of tendons involved are referred to as the extensor tendons which act to straighten the wrist and fingers. For most patients (80%) symptoms will settle within three or four months helped by a combination of rest, ice and anti-inflammatory medication although it is also common for patient's General Practitioners to administer a steroid injection in the early stages.
However, in about 20% of patients the condition persists and is functionally quite disabling because it does limit use of the arm quite significantly. This is often when the patient gets referred to see an orthopaedic surgeon and at that stage if patients have had all the simple treatments we would start to consider injections and, perhaps most importantly, physiotherapy. Commonly steroid injections have been used but there is some evidence that a new generation of injections known as PRP, or platelet rich plasma injections, are more effective than steroid injections. Physiotherapy treatment is very important in tennis elbow which attempts to not only treat the swollen, painful tendon attachment but also change the mechanics of how the tendon acts on the bone to prevent recurrence. Surgical aids such as an epicondylar clasp worn around the forearm below the elbow can also be helpful in controlling symptoms.
A new technique called Shockwave Therapy is also available now. This technique uses pulsed vibrations to create shockwaves and stimulate healing in the damaged painful tendon. This technique does not involve an anaesthetic and is perfoemd as an outpatient procedure lasting less than 10 minutes each week for 3 weeks. There minimal potential side effects and if successful then this may help the patient to avoid undergoing sugery for a tennis elbow release.
For a very small number of patients non-operative treatment, consisting of the above mentioned treatments, fails to improve their symptoms and surgery may then be indicated. At surgery a cut is made over the tendon attachment to the bone and the tendon attachment is raised off the bone with the damaged piece of tendon being removed. The back of the tendon is cleaned along with the bone attachment to create fresh surfaces to allow healing in a slightly different position which again alters the mechanics of the tendon origin. In over 75% of patients the operation will relieve their symptoms.
However, even with surgery about 20 to 25% of the patients will not experience significant improvement in their symptoms.