Tennis Elbow Treatment
Complex joint movement requires specialised care
What is Tennis Elbow?
Tennis elbow is the common name for an overuse injury called lateral epicondylitis. It’s caused by inflammation of the tendons that attach to the bony prominence on the outside of our elbow (the lateral epicondyle).
The elbow is a complex joint that’s formed by the joining of three bones: the humerus (upper arm bone), ulna (outer forearm bone), and radius (inner forearm bone). These bones are covered with muscle and ligaments, as well as a protective synovial membrane that lubricates the bones to eliminate friction as we move our arms.
While the complexity of our elbow joint allows a wide range of motion, it’s also susceptible to inflammation and injury when we overload and stress our forearm muscles. This can lead to painful inflammation of the tendons, muscles, and synovial tissue.
Causes of Tennis Elbow
Tennis elbow can be caused by injury secondary to overuse and muscle strain.
As the name suggests, Tennis Elbow is a common injury in people involved in sports and other activities that require repetitive muscle contractions at the forearm. Most commonly, the condition is associated with age-related changes in a previously normally functioning tendon. This can be associated with painful function. The changes within the tendon can lead to tearing of the common extensor tendon origin, which may progress with time.
Tennis players, painters, knitters, typists, gardeners and musicians tend to be susceptible to the condition. It most commonly occurs in people between the ages of 35 and 55, although it can happen in anyone who overuses their forearm tendons.
Do you have These Symptoms?
The most common symptoms of Tennis Elbow include pain and tenderness, usually on the outside of the elbow.
Symptoms may develop slowly over time, or happen suddenly after an intense sporting session or strenuous day at work
The pain and weakness associated with Tennis Elbow may make it difficult to:
- Shake hands or grip objects
- Turn doorknobs
- Grip a pen or small object
- Hold a coffee cup
The pain can vary from mild discomfort to severe pain that keeps you up at night. If you have severe elbow pain, can’t move your elbow or have a loss of feeling in your elbow, arm or hand, see your GP right away.
Diagnosing Tennis Elbow
Usually, a diagnosis can be made based on the history of the injury and the results of a physical examination.
Your GP will look for inflammation, swelling, or tenderness in your elbow and wrist, and will also test your range of function to see how much the problem is inhibiting your ability to move normally.
Your GP may also order X-rays to help rule out any other causes that may be causing your symptoms (such as arthritis). Sometimes, an ultrasound or MRI may be required to look for degenerative changes in your tendons too.
Natural and Home Remedies For Tennis Elbow
There are many options to treat Tennis Elbow at home, especially if your symptoms are mild. Conservative treatment options for treating your symptoms may include:
- Limiting the use of the arm and resting it completely from activities that worsen symptoms
- Using a splint or brace to decrease stress on the injured tissues
- Lifting objects with your palm facing up to put less strain on your forearm muscles
- Applying ice packs to the elbow to help reduce swelling
- Taking over-the-counter anti-inflammatory medications such as ibuprofen
- Light elbow and wrist stretching activities to improve muscle healing
Most patients successfully relieve their symptoms using these non-surgical, conservative treatments. If your symptoms haven’t abated after six months or so, see your GP for a referral to Dr James McLean.
Steroid or Therapeutic Injections For Tennis Elbow
Depending on the circumstances of your injury, Dr McLean may recommend a steroid or other therapeutic injection to assist healing. Steroids such as cortisone are very effective anti-inflammatory medicines, and when applied directly into the area, they can help with symptoms.
The injection is done using image guidance (such as ultrasound) so the medicine can be delivered precisely in the right spot. It contains an anaesthetic, so it’s less painful. However, you may feel some mild discomfort during the injection and experience some redness and swelling afterwards.
Afterwards, you will need to protect the area for a few days and avoid vigorous arm movement.
Therapeutic injections are not suitable for everyone and do carry some risks. Dr McLean will assess your suitability for the procedure. If he decides it’s an appropriate treatment option for your condition, you will be referred for this treatment.
Arthroscopic Surgery for Tennis Elbow
If your symptoms haven’t resolved after many months, or if your pathology is particularly painful or disabling, Dr McLean may recommend surgery.
Surgery aims to address the damaged part of the tendon. This may involve cutting (releasing) the affected tendon, repairing or reattaching any tears, and/or removing tissue or bone spurs that are contributing to the problems.
Traditionally, the standard procedure for Tennis Elbow has been open surgical release. Dr McLean uses arthroscopy whenever possible, as arthroscopic methods offer a number of benefits that open release does not.
The Advantages of Arthroscopy
Commonly known as key-hole surgery
- Less post-operative pain
- Faster healing times
- Reduced risk of infection
- Minimal soft tissue trauma
- Less downtime from normal life
Additionally, elbow arthroscopy (key-hole) offers the ability to look inside the elbow joint and treat other associated conditions, which is not possible with open surgical release.
Most importantly, in open surgery, multiple tendons are released, whereas arthroscopy allows Dr McLean to only release the tendon that’s affected by Tennis Elbow. This allows for less weakness post-op and a faster return to sports.
Long-term Outcomes of Elbow Arthroscopy
Dr McLean will discuss these with you during your pre- and post-surgery appointments.
The prognosis for elbow arthroscopy is excellent. Influencing factors that may affect your individual road to recovery include the severity of the injury, the surgery performed, your recovery from surgery, and your adherence to your post-op care recommendations.
What Happens During Tennis Elbow Release?
Elbow arthroscopy is performed under general anaesthetic at one of Dr McLean’s hospital partners in South Australia.
During the procedure, Dr McLean will make a few small incisions to approach your elbow joint. He will then insert a small specialised instrument with a camera lens into the joint. The camera displays footage of inside your elbow on a nearby screen, which allows Dr McLean to see what’s going on inside the joint without needing to open you right up.
After evaluating the location of the injury, Dr McLean inserts a few more small instruments through 2 or 3 small additional incisions near your elbow. A sterile liquid is also flushed into the area to enhance the clarity of the area and restrict any bleeding. This allows Dr McLean to evaluate the joint and direct his instruments to fix the problem. Tissue is either repaired or removed depending on the pathology and what Dr McLean determines to be the best course of action. Any loose cartilage or bone spurs are also removed.
At the end of the procedure, the instruments are carefully removed, and the incisions are stitched up. A sterile dressing is applied, and you’re off to the recovery room. The procedure itself takes about 30-45 minutes, but you should expect to be in the hospital for the day.
Tennis Elbow Surgery
After surgery, you will not need to wear a splint or sling.
Slings potentiate stiffness and are not recommended following surgery.
You might feel sore for a few weeks. Applying ice to the area and using pain relievers may help reduce inflammation and discomfort.
From the day of surgery, you can stretch your elbow and start moving it gently. Dr McLean will recommend a physical therapy exercise program that is designed to strengthen the elbow and surrounding muscles again.
Talk to your employer about a return-to-work plan for you. You may have to perform light duties for a few weeks as you recover.
Getting back to strenuous exercise (such as using weights), sports, and heaving lifting might take a few months. Everybody is different, and Dr McLean will monitor your recovery and advise you of your timeline during your follow-up visits.