Tennis elbow also known as lateral epicondylitis is the most common source of pain at elbow level. Pain is normally on the lateral (outside) aspect of the elbow and is exacerbated by resisted extension of the wrist. It affects up to 50% of tennis players and is common in painters or plumbers whose jobs involve repetitive motions of the wrist and arm.
What are the symptoms?
Pain on the lateral aspect of the elbow that sometimes radiates down the arm and weakness are symptoms of tennis elbow. Patients may find it difficult to lift things, shake hands or twist arm and also may have decreased grip strength.
Do I need any scans?
Tennis elbow is a clinical diagnosis however it is common to have an x-ray to exclude other causes for pain in the elbow. If the diagnosis is not clear an MRI scan may be necessary. Occasionally an injection with local anaesthetic may be useful to differentiate between a tennis elbow and a radial tunnel syndrome.
What is the non-surgical treatment?
In the majority of cases tennis elbow resolves over time with conservative management, including physical therapy, non-steroidal anti-inflammatory medications and cortisone (steroid) injections. I do not recommend steroid injections as steroids may kill healthy tendon cells and in long term may make tennis elbow worse by inhibiting the healing process.
Is PRP good for tennis elbow?
One of the best-studied treatments for tennis elbow is a platelet rich plasma injection. Your own blood is taken, concentrated in a centrifuge, and injected into the diseased tendon. Unlike steroid, PRP should not wear off and will hopefully heal the tendon. When comparing PRP to steroids, Gosens et al. showed PRP to be more effective. Responses to treatment vary, but most patients will need one to three injections. Each set of treatments may be spaced approximately three to four weeks apart.
When do I need surgery? If you suffer with tennis elbow for more than 6 months and you failed to improve with conservative management then surgery may help. The procedure is performed under general anaesthesia and takes about 40 minutes. It can be done either open or keyhole (arthroscopically). During surgery, the affected tendons are released from the bone and the damaged tissue is excised.
What is the success rate of surgery? The success rate of surgical tennis elbow release is around 90 %
What can I expect after surgical tennis elbow release? You will have a bandage around the elbow that can be removed in 48 hours. Normally you can go home the same day and use your elbow as comfort allows. Heavy lifting is usually restricted for 6 weeks and you can expect to resume office jobs in 1 or 2 weeks. Physiotherapy will be organised at the first follow up visit at two weeks following surgery. A full recovery takes up to 4 months.