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Tennis Elbow

An article in the National newspaper the Daily Mail

The above is a video of arthroscopic tennis elbow release being performed


A common condition where the outer part of the elbow becomes painful, possibly due to repetitive grasping. The name was first used in 1883 by Major in his paper "Lawn-tennis elbow"1

It can also be caused by injury.
It is also called lateral epicondylitis. This is a misnomer - as 'itis' means inflammation, and there is little inflammation in this condition. It is a degenerative (wear and tear) process mainly affecting the Extensor carpi radialis brevis (ECRB) muscle.

There is pain in the lateral (outer) aspect of the elbow, and this is made worse by resisted wrist extension

Management

It has been appropriately stated in a recent paper attempting to review the treatmont options for this condition that 'There is much withcraft and psedoscience involved in the treatment of patients with lateral tennis elbow'2

The various treatment options are noted below, in the order of increasing invasiveness of the intervention

  • Activity modification with avoidance of activities causing pain should be the first line of treatment. 
  • Tennis elbow strap - may reduce the forces at the tendon origin, and may protect from further damage. Some patients find it beneficial
  • Physiotherapy - 'Eccentric' (lengthening) physiotherapy has been shown to be effective in some cases.
  • Extracorporeal shockwave therapy - acoustic shock waves are directed at the affected area through the skin. This is relatively painfree and can be performed as an office procedure. There is limited data on its efficacy. NICE (National Institute for Health & Clinical Excellence) have published guidelines on its use
  • Steroid injections - Often provides temporary improvement, but evidence shows no long term benefit2 . Complications include skin problems with subcutaneous fat atrophy as well as further damage to the affected tendon.
  • Platelet-rich plasma (PRP) - This is using patients own blood which is processed to create high concentration of growth factors that promote tissue healing. This is a relatively new procedure, but there is some evidence that it can be effective.
  • Surgery - Only suitable for cases that fail to improve after extensively trying the other treatment options. Can be done as a traditional open operation, or using a newer arthroscopic (keyhole) technique. This has certain advantages (treat other associated conditions, only release the affected tendon) and can lead to quicker recovery, grip strength is also less affected by this technique.

  • Pictures of Arthroscopic tennis elbow release

  • Our Experience with keyhole surgery has been presented at European Federation of National Associations of Orthopaedics & Traumatology meeting

 

 References

 

 

  1. Major HP. "Lawn-tennis elbow". BMJ. 1883;2:557
  2. Lateral tennis elbow: “Is there any science out there?” Martin I Boyer, MD, MSc, FRCS(C) Hill Hastings II, MD - Journal of Shoulder and Elbow Surgery Volume 8, Issue 5 , Pages 481-491, September 1999
  3. Haines T, Stringer B (April 2007). "Corticosteroid injections or physiotherapy were not more effective than wait and see for tennis elbow at 1 year". Evidence-based Medicine 12 (2): 39. doi:10.1136/ebm.12.2.39. PMID 17400631.