Reading
Berkshire
Harley Street
London
What?
Tennis elbow is also known as Lateral Epicondylitis. This is a condition which causes pain on the outer side of your elbow due to degeneration (Wear and tear) and inflammation of the area where the tendons of your forearm muscles attach to the elbow. The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury.
Why?
Tennis elbow is an over use injury due to repetitive over loading of your forearm muscle that involve bending your wrist back and extending your fingers (Extensor Carpi Radialis Brevis) . These muscles attach to the outer bony edge of your elbow called the epicondyle through tissue called tendons. It is wear and tear (degeneration) and Inflammation of these tendons from repetitive loading/ over use that leads to pain.
Who?
How?
Despite what the name suggests Tennis elbow does not occur exclusively occur in Tennis players. Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. It is thought that the repetitive manual tasks and lifting pre-disposes to tennis elbow in these occupations.
DIAGNOSIS:
The diagnosis of Tennis elbow is made from your symptoms and with specific tests that reproduce your pain. Specifically pain on the outer part of your elbow and weak grip strength.
The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or using a screwdriver.
Examining the elbow involved pressing near the lateral epicondyle (Outer bony edge of the elbow) where the ECRB tendon (Main tendon affected) inserts and testing the strength of your wrist and finger extension (Keeping them straight against resistance). Both of these will cause pain.
There are of course other problems such osteoarthritis, ligament damage and nerve inflammation that can cause similar symptoms and these may have to be investigated with an X ray and/ or MRI scan of your elbow.
TREATMENT:
-
Tennis Elbow in 90% of cases resolves over time (Self-limiting). However, this usually takes on average 6 -12 months to resolve. The initial line of treatment is to reduce overloading your forearm and to wear a Tennis elbow brace/ Clasp for a period of 3 months. (Tennis elbow brace can be bought online or from any health care shop)
-
It is also important to seek advice on your sporting activity technique or work supervisor to make adjustments/ corrections to help reduce overloading. (Please see Useful External Links)
-
Physiotherapy which concentrates on stretching and gradual strengthening program helps with recovery. This is the first line of treatment.
-
Cortisone/ Steroid injections help reduce pain by reducing inflammation. Cortisone injections have the most impact within 6-8 weeks of getting symptoms. However, there are reports to suggest steroid injections can make symptoms worse at 1 year in some patient who continue to have symptoms. I do not recommend repeated cortisone injections as this can potentially weaken the tendon.
-
PRP (Platelet Rich Plasma) is used in the treatment of Tennis elbow and the evidence is growing about its effectiveness. PRP treatment aims to regenerate the damaged tissues which lead to Tennis elbow by using concentrated bloods cells known as platelets which are important in healing and clotting. A UK study has shown PRP is effective in 70% of patient avoiding the need for surgery but other studies have not shown any benefit over physiotherapy or steroid injections.
-
Tennis Elbow Surgery is considered when all other non- invasive treatments have failed. Surgery involves releasing the ERCB tendon which is tendinopathic (wear and tear) or repairing the tendon if it has fully torn. The aim of tennis elbow surgery is to remove the diseased tissue around the outer elbow, improve blood supply to the area, and alleviate your symptoms.
Me?
The decision to undergo surgery for Tennis elbow is yours and my job is help guide you. It is important to remember surgery is reserved for resistance cases after non-operative treatment options have failed to improve your pain. Enough time must be given to allow your elbow to 'self - resolve', that is naturally heal itself. 90% of patients settle down without the need to go onto have surgery within about 6 months.
Surgery is considered a last resort for the treatment of persistent pain. The success rate of surgery for relieving tennis elbow pain is 85-90%.
Surgery is performed under General Anaesthetic. Risks include infection, nerve and vessel damage (<1%), persistent symptoms (10%), stiffness.
Help?
Useful external
patient/ Sports physio info links:
How long do I wear a sling?
The sling is for comfort and should be discontinued within 5 days.
When can I start to drive?
You should not drive whilst your arm is a sling. Generally you can start to drive after 2 weeks once your wound has been checked and sutures trimmed. You should be able to fully control wheel.
When can I go back to work?
This depends on what your job involves. Repetitive manual work, heavy lifting and long duration of typing should be avoided for 2 weeks. Activities need to returned gradually with breaks for rest. I generally advice patients 6 weeks of modified duties.
When can I start to play sports/ Go back to the gym?
It is important that you focus on physiotherapy exercises for the first 6 weeks at least. If you are progressing well with these then you can gradually build in light sporting activities starting of gentle and progressing in incremental duration. It is important that you look at your technique to ensure any adjustments are made to avoid overloading you forearm muscles unnecessarily.
If your elbow hurts then your body is telling you it needs more time to heal.
Paul Marquis PT How tp fit a Tennis elbow brace
BESS Tennis elbow exercises
Golfers Elbow
What?
Golfers Elbow is also know as medial epicondylitis. It is condition which causes pain on the inside of your elbow due to degeneration (Wear and tear) and inflammation of the area where the tendons of your forearm muscles attach to the elbow. It is similar to Tennis elbow but much less common.
The symptoms of Golfers elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury.
Why?
Golfers elbow is an over use injury due to repetitive over loading of your forearm muscle that involve bending your wrist and clenching your fist. These muscles attach to the inner bony edge of your elbow called the epicondyle through tissue called tendons. It is wear and tear (degeneration) and Inflammation of these tendons from repetitive loading/ over use that leads to pain.
Who?
Despite what the name suggests Golfers elbow does not occur exclusively occur in Golf player. Painters, plumbers, and carpenters are particularly prone to developing Golfers elbow. It is thought that the repetitive manual tasks and lifting pre-disposes to Golfers elbow in these occupations.
How?
DIAGNOSIS:
The diagnosis of Golfers elbow is made from your symptoms and with specific tests that reproduce your pain. Specifically pain on the inner part of your elbow and weak grip strength.
The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or using a screwdriver.
Examining the elbow involved pressing near the medial epicondyle (Inner bony edge of the elbow) where the muscles that allow you to make fist and flex your wrist inserts. Testing the strength of your wrist and finger flexion (Bending your wrist and making a fist against resistance). Both of these movements will cause pain.
There are of course other problems such osteoarthritis, ligament damage and nerve inflammation that can cause similar symptoms and these may have to be investigated with an X ray and/ or MRI scan of your elbow.
TREATMENT:
-
Golfers Elbow in 90% of cases resolves over time (Self-limiting). However, this usually takes on average 6 -12 months to resolve. The initial line of treatment is to reduce overloading your forearm and to wear a Tennis elbow brace/ Clasp for a period of 3 months. The brace helps with both conditions by reduce the force going through the muscles. (Tennis elbow brace can be bought online or from any health care shop)
-
It is also important to seek advice on your sporting activity technique or work supervisor to make adjustments/ corrections to help reduce overloading. (Please see Useful External Links)
-
Use the right equipment. If you're using older golfing irons, consider upgrading to lighter graphite clubs. If you play tennis, make sure your racket fits you. A racket with a small grip or a heavy head may increase the risk of elbow problems.
-
Stretch before your activity.
-
Physiotherapy which concentrates on stretching and gradual strengthening program helps with recovery. This is the first line of treatment.
-
Cortisone/ Steroid injections help reduce pain by reducing inflammation. Cortisone injections have the most impact within 6-8 weeks of getting symptoms. However, I do not recommend repeated cortisone injections as this can potentially weaken the tendon.
-
PRP (Platelet Rich Plasma) treatment aims to regenerate the damaged tissues which lead to Golfers elbow by using concentrated bloods cells known as platelets which are important in healing and clotting. This treatment is currently classed as experimental.
-
Golfers Elbow Surgery is considered when all other non- invasive treatments have failed. Surgery involves releasing the Flexor tendons that are tendinopathic (wear and tear) +/- repairing the tendons if it they are torn. The aim of Golfers elbow surgery is to remove the diseased tissue around the outer elbow, improve blood supply to the area, and alleviate your symptoms.