This condition usually occurs with repetitive movement but can also happen after a specific injury. The pathology is in the tendon that attaches to prominent outer bone of the elbow (lateral epicondyle). The tendon may be degenerate, inflamed or may even have a small tear.
Patients often complain of pain on the outer part of the elbow with pain radiating into the forearm. This pain is worsened with clenching of the fist or extending the wrist, and is often noted when carrying heavy shopping. Elbow movement is also painful. Some patients may also experience tingling in the forearm.
How is the diagnosis made?
The diagnosis is often made from the history and the examination. The elbow often has full range of movement and is particularly tender on the outer (lateral) aspect. The pain is worse with resisted wrist or finger extension.
Scans (ultrasound or MRI) are sometimes done to confirm this and to rule out other pathologies.
What is the treatment?
The majority of patients improve with analgesia and specific exercises. Tennis elbow splints are helpful in some patients but not in the majority. If these fail injections can be tried. These may be steroid or PRP (protein rich plasma). Surgery for tennis elbow is possible but is reserved as a last option. Other modalities of treatments are available, including shock wave therapy and barbotage (needling on the tendon), but all with varying levels of evidence. The treatment options are best discussed with the treating doctor and can be tailed around the patient’s needs.
Surgery is performed as a day case procedure under general anaesthetic. Recovery after surgery is variable, but there will be a dressing and bandages for a maximum of 2 weeks, when the stitches are removed. It will not be possible to get the operative site wet until then. The patient is able to move the elbow but there will be some restriction and discomfort. It may take a couple of months before achieving complete relief.
Risks of Surgery
Surgery carries the risks of infection, bleeding, nerve injury, stiffness, failure of the procedure, recurrence of the symptoms and elbow instability.