Tennis Elbow

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Lateral Epicondyitis, or Tennis Elbow, is a very common condition which presents with pain on the outside of the elbow when you try to make a grip or pick things up. The main problem is not actually inflammation in the tendon but degeneration in the tendon probably due to a lack of oxygen getting to the tissues. These damaged cells never completely heal and there is a proliferation of vascular and fibrous tissue.

The cause is usually a cumulative trauma injury and is commonest in the 40 - 50 age group. It is less common in people playing regular sports and it is rare in tennis players! Things such as poor technique, especially on the back-hand at tennis, and having a grip that is too small or too large on your racquet or golf clubs can cause it. It also results after overuse when doing an activity such as painting, screw-driving or poling when skiing.

The first line of treatment when you become aware of pain on the outside of the elbow is to avoid the activity that caused it and those that exacerbate it. Self medication with ice-packs and heat-packs, anti-inlammatory gels and tablets and a tennis-elbow brace is also advised.

If the symptoms persist then a steroid and local anaesthetic injection can be curative in over 40%.

Overall about 90% of cases will improve with a combination of some or all of these options.

If it recurs then surgery presents an excellent way of resolving the symptoms and is successful in over 90% of cases. In cases where the operation has not got rid of the symptoms then that mean the original diagnosis was incorrect and the patient may have Posterior Interosseous Nerve entrapment.

The operation I favour is called a 'micro-debridement' and its purpose is to encourage new blood vessels to grow back into the degenerate tendon and bring better oxygen supplies along with it to encourage the tendon to heal fully.

This is done as a day-case procedure usually under a light general anaesthetic and through a 2cm incision.

The results of this technique seem to be much better than traditional operations which cut the tendons and the recovery time is also much shorter.

I do advocate that you wear a sling for a week and aviod repeated or heavy activities with the arm for 4 weeks but day-to-day life should return to normal fairly quickly.