Tennis Elbow

At Schoen Clinic, you can receive comprehensive advice from our shoulder and elbow specialists and discuss which treatment is best for your symptoms.

Overview

Tennis elbow is a chronic degeneration of the tendons on the outside of the elbow. There’s many different treatment options available and up to 90% of cases can be treated effectively without surgery.

Tennis Elbow Symptoms & Causes

Tennis elbow is a painful condition caused by repetitive use or strain of these tendons. Symptoms include pain and weakness gripping with an extended wrist. This is a common movement in many sports and activities including tennis, shaking hands, pouring water and typing on a keyboard.

Diagnostics

Diagnosis is usually confirmed by clinical examination. However an x-ray may be requested to exclude other causes of elbow pain. Often an ultrasound scan is performed if an acute tendon tear or calcium deposits within the tendon are suspected and if an instability is suspected an MRI might be helpful to clarify the diagnosis.

Treatment

Up to 90% of tennis elbow resolves without surgery. Recommended treatment often includes activity-modification, physiotherapy, injections or shockwave therapy.

Activity-modification and physiotherapy: This is usually the first line of treatment. Avoiding repetitive and painful movements or modifying activities to use other muscle groups will provide symptom relief. Physiotherapy exercises aim to combine stretching exercises with exercises to strengthen the extensor muscles. This is usually effective in the long-term.

Injections: Platelet rich plasma (PRP) can be injected into the affected site. PRP is

extracted from your own blood and processed to obtain a concentrated solution of platelets containing growth factors to help the tendons heal. This aims to provide a long-term solution and there is some evidence that PRP injections achieve this aim. Alternatively injecting steroid locally into the affected area might provide short-term pain relief. Up to three injections can be given but recent scientific works have suggested the possibility that this technique might increase the duration of the disease.

Shockwave therapy: A machine delivers sound waves into the affected area. Reported rates of success are extremely variable and therapy can sometimes be considered an experimental or research treatment. However whilst we cannot guarantee that it will work, we do know, it is very safe.

Surgery: Surgery is usually performed as a day case and can be open or keyhole. The operation is usually very successful with 90% of patients improving significantly.

Rare complications of surgery include infection, nerve or blood vessel damage, weakness, stiffness, growth of islands of bone, prolonged rehabilitation and further surgery.

Aftercare

Pain: During surgery local anaesthetic is injected around the wound and the elbow is numb for a few hours. After this you will be given painkillers to take whilst in hospital and at home. Ice packs may also help reduce pain. Ice or frozen peas can be wrapped in a damp tea towel and applied to the elbow for up to 15 minutes.

Wearing a sling: At the end of the operation you will be placed into a bulky bandage dressing and a sling. These are for comfort and can be removed after 48 hours.

The wound: Keyhole surgery is usually performed through small 5-10mm wounds. With open surgery the wound will be a few centimetres in length. You may have dissolvable stitches or sticky strips over the wounds. You must keep the wounds dry and covered with a small dressing until they have healed. This usually takes 7-10 days.

Returning to work: This will depend on your job and your surgeon will advise you. You may be able to return to a desk job within a few days. However, manual labourers may need 8-12 weeks off work.

Driving: You will not be able to drive for about a week.

Leisure activities: You should not lift anything heavy or do anything very active for approximately 6-12 weeks. Contact or high risk sports may need to be avoided for six months.

Follow-up appointment: You will be seen in outpatients by your surgeon three weeks after surgery. Further follow-up appointments are tailored to the individual but often occur around 3-6 months after surgery.

Physiotherapy: Before you go home your physiotherapist will teach you some exercises for you to practice several times every day. You should continue these exercises until you see the physiotherapist in outpatients. Recovery time is often slow due to poor blood supply in the area and slow healing of the tendons. Whilst some improvement can be seen after four weeks, it often takes between four and six months to regain good function and strength with a pain-free elbow.

Treatments are available at the following locations

Schoen Clinic London

Our Address
Schoen Clinic
Orthopaedic and Spinal Hospital London
66 Wigmore Street
London W1U 2SB
General Telephone Enquiries
+44 (0)203 929 0801
Specialist Areas
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Mr Adrian J Carlos

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Mr Giuseppe Sforza

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Dr Nora Ng

Consultant Rheumatologist, BMedSci BMBS MRCP (Rheum)

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Dr Roger Wolman

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