Tennis Elbow

This is a condition that is very common and causes pain in the outside portion of the elbow. It is also known as lateral epicondylitis, this name implies that it is inflammatory condition, but the actual pathology is a tendinosis of the insertion of Extensor carpi radialis brevis (ECRB) tendon on the lateral epicondyle. This means that it is a degenerative condition.

Symptoms

Pain is felt on the outside of the elbow and can radiate into the back of the forearm, Pain is aggravated by rotation of the forearm or gripping.

Usually pain follows a period of repetitive activities, but can occur after a single traumatic event. It is most common in the 40-50 age group and is more common in women. Even though it is thought to be related to degenerative tendon it tends not to occur in the elderly.

Examination

Localised tenderness on lateral epicondyle, pain is recreated on resisted wrist and middle finger extension as shown above. Passive wrist flexion can also produce pain. Movement at the elbow is usually full and X-rays are normal.

The majority of patients with tennis elbow symptoms will get better on their own and majority are better within 1 year. However many treatments have been described.

Non- operative treatment

  • Activity modification
  • Physiotherapy
  • Bracing
  • Injections

Activity modification

The main aim of this is to rest the damaged area, this depends on the activity that provokes pain. In normal activities it can be how a lifting task is performed. In sport, a technique or equipment change may cause aggravation. It is important that these factors are recognised and adapted as necessary. An example would be the thickness of grip on a tennis racket

Physiotherapy techniques are directed at reducing pain and swelling and promoting healing. This is then followed by a stretching and strengthening programme.

Bracing usually takes the form of clasp worn just below the elbow. This acts to prevent he forearm muscles from contracting maximally and relieving tension on the ECRB tendon insertion allowing healing to take place.

Injections are popular but there is little evidence to support their use. A recent study showed while there was good temporary relief of symptoms there was no difference between placebo treatment and injection at 1 year after treatment. Because of the proximity of the skin there is a risk of developing skin breakdown if too many are used

Surgical treatment

This is reserved for failure of resolution of symptoms. Any decision to operate must considered against the natural history of the condition to resolve. It is important that the diagnosis is correct.

Essential diagnostic criteria:

  • Pain on gripping felt at lateral elbow
  • Tenderness isolated to epicondylar ridge
  • Pain on resisted wrist extension

Surgical technique is varied and results are about 80-90% successful, recovery from surgery takes approximately 3 months.

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