What is Tennis Elbow?

Tennis elbow (lateral epicondylitis) describes pain on the outside or lateral part of your elbow when the tendons there are overloaded by repetitive movements of the wrist and arm. 

The repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist leads to inflammation and degeneration of tendons that attach the forearm muscles to the bony prominence at the outside of your elbow (lateral epicondyle)

You don’t have to play tennis to develop a tennis elbow and athletes are not the only ones who get it!

What are the symptoms of Tennis Elbow?

Patients mostly have pain and tenderness over the body prominence (lateral epicondyle) on the outer surface of their elbow. The point of tenderness is where their injured tendons are connected to the bone. 

Pain may also travel to the forearm or upper arm when patients are doing things with their hands such as turning a doorknob, lifting something or grabbing a racket tight. 

What sort of actions or activities cause Tennis Elbow?

There might be a variety of circumstances and activities causing a Tennis Elbow symptoms as this is not only a sports injury. We can divide them into these two groups:

Racket and upper limb sports: 

• tennis
• badminton 
• squash 
• fencing, 
• weight lifting

Jobs and hobbies: 

• Carpentry
• Typing
• Painting
• Cooking

How does my surgeon or doctor diagnose tennis elbow?

Tennis elbow is a clinical diagnosis. This means that your doctor or surgeon makes this diagnosis based on the clinical history given by their patient as well as the thorough clinical examination that they perform on the painful limb. 

Imaging studies such as ultrasound or MRI scans are not necessary for diagnosis. However, your doctor may still request it if he or she is worried about something else such as the extent of the tear (partial or complete) or the nature of a painful mass. 

How Can I Take Care of My Tennis Elbow

If you feel pain when you move your elbow, hand or wrist, you should take a break from the specific activity which makes it worse. Refraining from aggravating activities helps to protect the elbow from further damage.

Recognizing Tennis Elbow Early

The early signs of tennis elbow may not be located at the elbow at all. You may notice pain in your forearm, upper arm, wrist and difficulty moving your hand. Occasionally, the bony prominence on the outside of your elbow might be tender or inflamed. This is a clear sign of tennis elbow.

Selfcare

Tennis elbow is usually self-limiting and may disappear after a few days of reduced physical activities and rest. It is important to diagnose this injury once you experience pain on the outside of your elbow. 

Reduce elbow swelling and inflammation by applying ice for 30 minutes every 3 to 4 hours for a few days or until the pain is gone.

Anti-inflammatory medication can also help to reduce the pain and swelling, thus accelerating your recovery. 

Consider wearing a forearm muscle splint, or brace, for either tennis or golfers’ elbow. This brace is worn about two finger-breaths below the elbow crease and works by taking the strain off the affected tendon. It is recommended to wear the brace even when you are not playing tennis, and for a period of about 4 to 6 weeks.

Adapting to Changes in Sport and Work

Epicondylitis isn’t always caused by playing tennis. A number of other sports may cause the tendon in your elbow to snap. A few of them are volleyball, javelin, golf or even manual jobs like gardening and plumbing with a bad technique. Here are a few ways to help your elbow stay safer even while playing or working.

Sports:

1. Adequate warm-up exercises to loosen stiff joints and grant you a smoother swing.
2. Improve your swing technique. Having a tennis elbow may be an indication of a poor swing.
3. Ensure the grip of your racket is not too tight. This might also happen if the grip is too small. Consider changing the size of your racket grip or use double tapes to increase the size of your grip. The larger the grip, the less tendency for your to grip your racket too tight. 
4. Wear a brace while you play. An elbow brace limits the range of motion so that you do not force your healing elbow out of its comfort zone.
5. Consider wearing splints while you rest. If the pain is too severe and begins to impair your sleep quality, you may wear a wrist splint while you sleep so that you are not jolted from sleep by sharp wrist pains. 

Work:

1. Use hand tools equipped with a shock absorber to continue physical work.
2. Where possible, switch out manual tools with power tools.
3. Wear a brace while you work. A shock-absorbing brace will have the most effect.
4. Consider asking your employer to temporarily transfer you to another department where you do not have to flex your elbow as much.

Management of Tennis Elbow at Orion Orthopaedic Surgery

If your lateral elbow pain does not improve despite rest, ice and anti-inflammatory medication, a formal assessment from Dr Mizan is advised. An in-depth clinical history will be obtained to ascertain the cause of the pain, duration and aggravating factors. 

A thorough clinical examination will be performed to confirm the diagnosis of tennis elbow. Other causes of elbow pain may include golfers’ elbow, fractures, nerve entrapment and elbow dislocations. 

If required, Dr Mizan may organize radiological investigations such as x-rays, ultrasound scans or an MRI scan to exclude these other differential diagnoses. 

Treatment of tennis elbow may include the following: 

• Anti-inflammatory medication
• Physical or physiotherapy
• Elbow brace
• Injections to the painful area

Surgery for tennis elbow is rare and is only considered if all the conservative techniques have failed. 

Oral Therapy for Tennis Elbow Treatment

Non-steroidal anti-inflammatory drugs (NSAIDs) effectively mitigate inflammatory pain caused by the tennis elbow. Your pharmacist may recommend Diclofenac, Ibuprofen, Naproxen, amongst others, depending on the severity of the pain experienced. If oral medications are inadequate or are contraindicated, your doctor may recommend topical therapy.

Topical Therapy for Tennis Elbow Treatment

Patients with gastric or kidney problems often prefer topical therapy over oral medication. These topical anti-inflammatory medication may be applied over the area of pain perhaps two or three times a day when required. 

Ice

Applying an ice pack to the painful area for 10 to 15 minutes helps to relieve pain.It reduces blood flow to the area which in turn reduces swelling and pain. 

Steroid and local anaesthetic injections

Steroids have long been used by doctors with good effect for patients with pain. 

While long-term steroid use is commonly associated with negative systemic side effects, single doses of steroid injections are highly effective and have little systemic side effects. These steroid injections are given with local anaesthetic to reduce the pain, swelling and long term disability which patients may experience from their injuries. Their effects are felt locally where the injection is given and not systemically to the rest of the body. 

To improve the accuracy of where these steroid injections are given, the injections may be done under ultrasound guidance. Some possible local side effects include skin pigmentation, local swelling or minor bleeding.  

Shock wave therapy

Extracorporeal shock wave therapy (ESWT) is a beneficial method for treatment of tennis elbow. Studies have shown that ESWT stimulates soft-tissue healing and inhibition of pain receptors. ESWT is safe, helps reduce pain and promotes early return to daily activities. 

Physiotherapy

Physiotherapy for tennis elbow includes specific exercises, massages, ESWT and the use of medical devices such as braces and splints. Physiotherapy is safe and empowers patients to apply self-care to their injuries to improve their symptoms and prevent recurrent injuries. 

Do I need surgery for Epicondylitis?

Surgery for tennis elbow is not common, but if the joint causes severe and persistent pain, your orthopaedic doctor may suggest either open surgery or arthroscopic surgery.

Open or key-hole surgery for tennis elbow is aimed at reattaching the torn tendon to the bone (lateral epicondyle of the elbow). Patients are usually under general anaesthetic and may be discharged on the same day. 

Conclusion

Tennis elbow (lateral epicondylitis) is a fairly common condition characterized by pain over the lateral or outside portion of your elbow. It may be treated conservagively by avoiding aggravating activities, rest and anti-inflammatories. Physiotherapy and ESWT both help reduce symptoms and return patients to their active lifestyles. Surgery for tennis elbow is uncommon.