Tennis elbow (lateral epicondylitis)

We will help you return to your everyday life

Repetitive motion of the wrist while playing tennis is the common cause of this condition but although its name suggests it, this condition is not exclusive to tennis players. Other repetitive gripping activities can also be the cause of tennis elbow, including painting, gardening or even frequent computer mouse use.

Our specialists at Schoen Clinic London will help you to relieve your elbow pain. Together we will discuss which treatment is best for your symptoms.

Understanding your elbow

The elbow joint is the point of articulation between the upper arm and the forearm. It is made up of three bones, the humerus (upper arm bone) and the radius and ulna, which together form the forearm. The elbow joint is held together by muscles, tendons and ligaments, which all work in partnership to provide function and mobility to the elbow.

What is tennis elbow?
Tennis elbow is a chronic degeneration of the tendons on the outside of the elbow. In cases of tennis elbow, the tendons that connect the forearm muscles to the outer elbow (the lateral epicondyle) become inflamed and this can cause pain. There are many different treatment options available and up to 90% of cases can be treated effectively without surgery.

Tennis elbow symptoms

The symptoms of tennis elbow usually begin to appear gradually, as the condition is a progressive one, rather than related to an acute injury. As the condition progresses, the associated pain gradually increases over the course of a few weeks or months.
  • Mild pain on the outer elbow, gradually increasing over time
  • Weakness in grip
  • Usually only the dominant arm is affected
  • Pain worsens with activity

What causes tennis elbow?

Tennis elbow most often occurs with overuse of the forearm muscle. As the muscle repeatedly contracts each time you straighten your arm, it can cause a strain on the tendon which attaches it to the outside of the elbow. Over time, this repeated action can cause small tears in the tendon, which become painful and inflamed as the condition progresses. This is a common movement in many sports and activities including tennis, shaking hands, pouring water and typing on a keyboard.

There are several risk factors which may make you more susceptible to experiencing tennis elbow. The first and most obvious relates to physical activity. Participating in sports that require repetitive strain on your forearm muscle will of course be a factor. Age can be an indicator as the condition is most common in adults between 30 and 50 years old, though it does affect people of all ages. Occupation is another important factor as painters, butchers, plumbers and other professions also require some degree of repeated motion in the forearm.

How we diagnose tennis elbow?

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. If an instability is suspected an MRI might be helpful to clarify the diagnosis.

Tennis elbow mostly resolves without surgery

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

Activity-modification and physiotherapy

Physiotherapy is usually first-line treatment in managing tennis elbow. Avoiding repetitive and painful movements or modifying activities to use other muscle groups will provide symptom relief. Physiotherapy exercises for tennis elbow 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 a 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.

Tennis elbow surgery

Surgery for tennis elbow 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.

Tennis elbow: Our specialists

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

Tennis elbow: Our specialised hospital

With state-of-the-art diagnostics at your fingertips and experts in the prevention, treatment and rehabilitation of all shoulder and elbow conditions, Schoen Clinic Orthopaedic and Spinal Hospital London will provide you with the best possible outcome.