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Mr. Mark Falworth, Consultant Orthopaedic Shoulder & Elbow Surgeon, London, Watford, Stanmore, UK / Elbow / Tennis Elbow / Lateral Epicondylitis

Tennis Elbow / Lateral Epicondylitis

Tennis elbow, also known as lateral epicondylitis, is a degenerative condition affecting the tendons that insert into the bony prominence on the outside (lateral) aspect of the elbow.

Causes & Risk factors

Tennis elbow most often affects individuals aged between 30 and 50 years. It is believed that the condition is caused by the repetitive use of the tendons involved in extending the wrist and fingers. These tendons, which travel up the forearm from the fingers and wrist, converge and insert into the bony prominence on the outside of the elbow, the lateral epicondyle. Symptoms of a tennis elbow can occur secondary to inflammation (neovascularity) of the tendons, the presence of small tears within the substance of the tendon and even an avulsion of the tendon form the lateral epicondyle. Whilst tennis players are classically susceptible to the condition, any individual who performs activities that require the repetitive use of the forearm muscles can be affected.

Symptoms

The most common symptoms are usually pain and tenderness on the outside aspect of the elbow, the pain can also radiate down the forearm. Although the pain is usually intermittent, with repetitive use of the arm, it can be continuous. The pain is often worse when gripping or lifting objects.  In more severe cases the pain can occur during simple elbow movements or at night thereby disturbing sleep.

Diagnosis

The diagnosis is based on clinical examination. Ultrasound scans and occasionally MRI scans, can be helpful to exclude alternative diagnosis or indeed confirm degenerative changes at the lateral epicondyle. Radiographs may also be used to exclude other causes of pain from the elbow.

Treatment

In most cases non-operative treatments are successful. These include;

  • Rest, activity modification and anti-inflammatory medication can be used in the first instance.
  • Physiotherapy treatments, which include stretching and range of motion exercise regimes can be utilised.
  • Tennis elbow splints can also be used to aid recovery.
  • Injections can be utilised to address the symptoms. Corticosteroid injections to the lateral epicondyle can be used to improve the pain. Usually no more than two or three injections are used as they can cause further degeneration of the tendon and cause wasting of the fatty tissue below the skin. Platelet Rich Plasma (PRP) injections can also be undertaken and these are particularly helpful in managing interstitial tears of the common extensor origin. The aim of the PRP is to stimulate the healing of the degenerative lesion.
  • Surgery, in the form of a tennis elbow release, can be used where non-operative measures have failed. The aim of surgery is to excise the diseased tendon tissue, which is the perceived source of the pain, and then create an environment for the normal tendon to heal back to the bone. This is done through a small incision, measuring approximately 3-4 cm over the bony prominence on the outer aspect of the elbow. The surgery is usually performed as a day case procedure and you are discharged from hospital in an elbow bandage with a physiotherapy programme which slowly encourages the elbow back to full function over a three month period. Failing to complete the physiotherapy programme, or indeed trying to return to full activity too soon, increases the risk of residual symptoms. Tennis elbow surgery is usually successful in 85 -90% of patients.