Tennis elbow also known as lateral epicondylitis is by far the commonest elbow condition that
I see in my practise. It is a condition that involves pain on the outer aspect of the elbow
as well as swelling and tenderness. Paradoxically, less than 10% of people who suffer from tennis
elbow have actually played tennis. In medical terms, it is a chronic recurring condition
called tendinosis which involves microtrauma and repetitive injury to the area of the lateral
epicondyle. Before our muscles called the forearm extensors attach to a common extensor
origin tendon that attaches on that Loney point, this is the main tendon involved in
tennis elbow disease.
Tennis elbow is incredibly common in office workers. We sit at a desk all day typing on
the computer or work with their mouse, they get pain and tenderness as well as swelling
in the forearm muscles especially pain on the outer aspect of the elbow. This can be
debilitating and sometimes people are unable to open a door or shake someone's hand. There
is also morning stiffness that people can experience and the inability or disability
to grasp objects at a distance. This obviously becomes a nuisance after some time because
people cannot go about doing their activities of daily living including their sports and
hobbies. If this persistent dull ache carries on for the first three weeks and you find
you're unable to complete your activities of daily living at work, in the office or
even at home, you should not hesitate to go and see your general practitioner and see
a specialist.
Physiotherapy is crucial and an integral part of the pathway in tennis elbow treatment.
Physiotherapy involves stretching the extensor tendon along the lateral epicondyle. Performing
stretches in the first four to six weeks is highly beneficial for tennis elbow treatment.
Thereafter, patients can do strengthening activities which will indeed cure the problem
long term. There are ways and means to get to the physiotherapy and as far as injections
are concerned, I do not recommend steroid injections. There is some recent literature
that has shown that steroids can be harmful in the long term for tennis elbow. However,
new information has come to light with regards to platelet-rich plasma injections otherwise
known as PRP. What PRP involves is taking blood out of the patient's arm, then putting
that sample in a special machine called a centrifuge machine. The blood spins for five
to ten minutes and then we re-inject the blood back onto the affected area. The platelet-rich
plasma protein is indeed the blood that has been gone around the machine, has been enriched
with cells that we all have in our own body called platelets. The platelets contain a
significant and different growth factors that are involved in dealing with inflammation
and dealing with the pain and sometimes even can promote healing to the damaged tissue.
I strongly recommend platelet-rich plasma protein treatment to patients that come and
see me in the acute stages of tennis elbow. Surgery is reserved for those very resistant
cases that fail to respond to non-operative management, such as injections and physiotherapy.
Surgery involves a general anaesthetic and in a small incision along the lateral epicondyle
of the elbow releasing the diseased portion of the tissue that is inflamed and reattaching
the healthy tissue back on the bone with special anchors. This can be done either by open surgery,
like I said, with a small incision or sometimes via arthroscopic elbow surgery as well depending
on the severity of the condition. It is rare that I advocate surgery because in the vast
majority of cases, non-operative management works very well.
In reality, in most cases, tennis elbow is a self-limiting condition and variably it
will settle without any additional treatment. However, this may take a few months and up
to two years in a lot of cases. It is not uncommon for this to become very chronic and
for people to be very debilitated by this. That is exactly the reason why I do not want
most individuals to wait that long for this to happen. They should seek treatment early
and specifically and come and see us to have a special treatment plan with regards to platelet-rich
plasma injections, physiotherapy. That way their quality of life will improve much quicker.