What is it?
Tennis elbow (lateral epicondylitis) is present in 1% to 3% of people. It is most frequent between 40 and 50 years of age and in the dominant arm. The cause is poorly understood but it is thought to be due to a micro-injury at the origin of the extensor muscles (common extensor origin) on the outer side of the elbow. These muscles normal actions are to lift up the wrist and fingers. Whilst some regard overexertion as a causative factor, there is little evidence that it is commoner among manual workers (or tennis players !).
Tennis elbow causes pain on the outside of the elbow that often radiates to the forearm. The pain is usually aggravated by use of the arm, particularly lifting. A positive test is pain when resisting wrist and middle finger extension.
What can be done ?
Many treatments have been described; many are a waste of time!
Steroid injections can result in short-term relief of symptoms but studies have questioned the success in the long term. A maximum of 2 injections is my limit over a treatment period (6 months to a year). Risks of injection include pain, infection, skin discolouration and thinning of the fat and skin over the area.
Other treatments include anti-inflammatory drugs, physiotherapy, acupuncture, splints/clasps, and increasing the size of the handle on sports rackets. It is my opinion that it is worth trying all these modalities during a treatment course if the symptoms are not settling. Studies have not shown any clear benefit from any particular type of treatment.
The natural history of tennis elbow is a slow (12-18 months) resolution of the problem for the majority of people. Treatments discussed above probably do not change the natural course of the problem, but may help in offering some relief of symptoms for a period of time.
Stem Cell is a technique where blood (bone marrow) is taken from the pelvic bone and injected around the site of pain. It is thought to work as an anti-inflammatory. This is a newish technique and the longterm results are not fully known, however success rates appear to be 60-70%.
Shockwave therapy is a non-invasive technique, which stimulates the bodies’ own healing process. Success appears to be at around 60-80%. This procedure is useful in selected patients. Further information can be sought at www.shockwavesouth.co.uk
Surgery is considered in patients with severe or chronic tennis elbow and little or no response to treatment. This involves release of the common extensor origin through a short incision on the side of the elbow. This does not cause a long-term weakening of the arm once the muscle has healed. Success rates appear to be about 80%, however post operative rehabilitation can be prolonged.
The operation is usually performed under general anaesthetic as a day-case. The elbow will be dressed with a supportive dressing that permits movement and light hand use. Occasionally you will be put in a Plaster of Paris for 2 weeks.Your stitches will usually be dissolvable. Timing of your return to work is variable according to your occupation and you should discuss this.
Nerves running in the region can be bruised or damaged during the surgery and form a painful spot in the scar (neuroma) or numbness down the side of the forearm.
Any operation can be followed by infection and this would be treated with antibiotics.
You will have a scar on the elbow. This will be somewhat firm to touch and tender for 6-8 weeks. This can be helped by massaging the area firmly with moisturizing cream.
The symptoms and your function will recover slowly and it will probably be six months before you will get your final result. Success rates for surgery are in the order of 60-80%.