INTRODUCTION
Tennis elbow is a common condition that affects both men and women equally. It tends to occur after the age of 40 and affects the dominant arm 75% of the time. Activities that involve repetitive wrist extension can contribute to the development of tennis elbow. It commonly occurs in people with occupations that involve repetitive wrist flexion and extension and in those who play racquet sports as the name suggests.
ANATOMY
The medical terminology for tennis elbow is common extensor origin tendonosis. This is because the forearm muscles that control wrist extension stem from a single common tendon that originates from the bump of bone at the outside part of the elbow. Tennis elbow occurs when this common tendon is injured.
DIAGNOSIS
People with tennis elbow often describe an insidious onset of pain at the outside part of their elbow that is made worse with wrist extension. There is usually tenderness at the bump of bone on the outside of the elbow. The pain may also be reproduced by wrist extension.
INVESTIGATIONS
X-Rays are not usually required for the diagnosis of tennis elbow. Sometimes an ultrasound or MRI scan may be performed to confirm the diagnosis.
TREATMENT
There are many treatment options for tennis elbow ranging from pain relief to attempts at healing depending on the acuity and severity of the condition.
Pain Relief
- Ice – useful for acute pain
- Medications – Paracetamol and non-steroidal anti-inflammatory (e.g. Ibuprofen)
- Counterbrace – these should be placed over the forearm just below the site of pain
- Acupuncture
Soft tissue therapy
Soft tissue releases of the forearm performed by a manual therapist e.g. physiotherapist may provide pain relief as this unloads the strain of the common extensor tendon origin.
Exercises
Eccentric ‘wrist drop’ exercises should be performed at least daily to mechanically load the tendon and provide a direction for the fibres to heal. Ask your sports medicine practitioner to show you how to perform these exercises.
Activity Modification
Patients with tennis elbow may have to reduce or even completely cease the aggravating activity to adequately rest the injured elbow. Those playing racquet sports may wish to have their grip or stroke technique corrected by a professional or coach.
GTN Patches
Tendon injuries have a slow recovery time because they have a poor blood supply. Recent studies have shown that low dose GTN patches (usually used in patients with coronary heart disease) can help improve tennis elbow.
Injections
A cortisone injection may provide short to medium term pain relief. Autologous blood and PRP injections are being more frequently used in the treatment of tennis elbow. This involves the injection of the patient’s own blood into the common extensor tendon origin.
Surgery
A small percentage of patients may require surgery for chronic and severe intractable pain.