I'm not surprised when patients say to me: "How can I have tennis elbow when I don't
play tennis?" The name is a hangover from when it was first described in the 1880s,
where patients were playing tennis with heavy wooden rackets and cat gut strings and this
heavy weight, particularly in a backhand and a repetitive activity was causing pain around
the outside of the elbow. This pain can be reproduced by any repetitive lifting activity
and it is something what we commonly see in people’s 40s or 50s. A time when generally
the skeleton loses the ability to repair and starts to wear and that's where the problem
lies with tennis elbow or lateral epicondylitis as the more official term. Tendon strands
start to break down. This is called mucoid degeneration. It doesn't mean the tendon is
falling apart, it just means that some of the collagen fibres are just not up to the
task being given to it at this stage in life. We see this scenario in other tendons in the
body. We see it in the shoulder where we call it rotator cuff impingement and we can also
see it in the back of the ankle: achilles tendonitis, or around the knee as patellar
tendonitis. It's not a disease and it doesn't mean the joints are going to work. It just
means that they're going through an ageing process. There's no inflammation as part of
this ageing and that's why anti-inflammatories such as Nurofen or Voltaren or steroid injections
may not give lasting benefit. In fact, most studies have shown that the best treatment
for tennis elbow is to let it burn out by itself and this will take place over the course
of a couple of years. It might be frustrating but it's good to know that it is a self-limiting
condition. There are things we have tried to help it along. Mostly we'll start with
making sure the diagnosis is correct and that's with an MRI scan. We can see there any degeneration
within the tendon insertion. If there's a big tear in the tendon, by which I mean a
number of collagen fibres have broken down, then there might be a role for surgery and
that would be to reattach the tendon. We are also using a relatively experimental technique
using platelet-rich plasma. We take blood from you, spin it in a centrifuge, and use
the good stuff: the gold layer at the top that has the healing factors and the platelets
that we normally have but in a concentrated form, and putting that directly into the sore
spot in the tendon, has shown a roughly 80 percent improvement in patients feelings of
pain. It may not solve the problem, but it may make things more manageable. Physiotherapy
is also really helpful in helping to understand and re-educate the muscle on loading that
tendon. So there are a number of techniques that may be helpful in addition to sitting
it out. I often tell my patients there are no old people with tennis elbow. So I do see
it burning out and that's reassuring to know.