Tennis elbow (or lateral epicondylosis) is a degenerative condition affecting the common extensor origin. The condition tends to affect middle age men (i.e. 30-50 years of age). It was orginally recognized commonly in Tennis players, hence the name, but the vast majority of cases are seen within the general population.
Tennis elbow is thought to result from repetitive small tears to the tendon insertion (most commonly of Extensor Carpi Radialis Brevis but can also involve Extensor Digitorum Communis). This leads to characteristic pain and tenderness over the lateral part of the elbow with activities such as gripping and lifting. The pain can radiate down the forearm.
Diagnosing Tennis Elbow:
radiocapitellar degenerative changes can cause lateral elbow pain. Crepitus may be felt on elbow movement.
Resisted elbow flexion and supination are painful.
Neck or shoulder pathology with referred pain.
Radiographs: AP/Lat of the elbow (to exclude other conditions such as radio-capitellar arthritis)
An MRI scan may also be requested to assess the soft tissues around the elbow in greater detail.
Here are available treatments for Tennis Elbow:
Resting from activities that exacerbate the pain will often help to improve symptoms. Poor sporting technique can worsen symptoms. Advice regarding this from a sports coach or physiotherapist can be helpful. A short course (up to six weeks) of anti-inflammatory medication taken regularly has been shown to improve symptoms, albeit in the short term. Excellent benefit can be obtained from physiotherapy.
The physiotherapist will use a combination of manual techniques, ultrasound and strengthening exercises (eccentric-based regimen). The use of splints/clasps and acupuncture may also derive benefit for some patients.
Injections for tennis elbow has been a topic of some discussion over the past few years. Traditionally injection of local anaesthetic and corticosteroid has been used with good benefit. Research has emerged suggesting that whilst these injections can improve symptoms for a while, they may make the pain come back worse than ever. We would therefore suggest that these injection be used sparingly now in the treatment of tennis elbow.
Injection of blood products:
The use of blood and blood derived products as an injection treatment for tennis elbow has been used for many years. Recent high profile sporting examples have focused media attention on this form of treatment. Autologous blood (2-3 mls) can be injected into the area of tennis elbow to provide benefit from symptoms. It is thought to deliver growth factors (such as PDGF, FDGF) directly to the area of tendon damage, promoting healing.
Platelet rich plasma (PRP) is made up from autologous blood that is placed into a centrifuge. This produces a concentrated solution containing a higher concentration of these growth factors. This can then be injected into the area of tendon damage to facilitate tendon healing. It has demonstrated promising results in the literature. This treatment is now available at Dorset Hand Surgery.
When to refer:
- If diagnosis is not clear.
- Failure of improvement with non-operative measures.
- Recurrence of symptoms following one steroid injection.