Common Conditions of the Elbow: Tennis elbow (Lateral Epicondylitis)

This condition is classically seen in tennis players although is common in golfers or anyone who has undertaken unnacustomed heavy manual work which involves a lot of lifting and carrying.

What are the signs and symptoms?

Pain is felt over the outside of the elbow joint. A small area (the lateral epicondyle) is usually exquisitely tender. The pain may spread down into the forearm. Gripping and carrying make the pain worse.

How is the diagnosis made?

The doctor will listen to the description of events and examine the elbow. X-Rays will also be taken to determine whether there is a piece of bone involved. Usually no further investigation is needed although sometimes, in difficult cases, ultrasound or MRI may be helpful.

What is the initial treatment?

Firstly it is important to determine why the condition occurred so that recurrence may be avoided. If it is sports related the equipment or grip must be altered. Often the raquet handle is too small or too big for the hand.

An injection of local anaesthetic and steroid into the most tender spot (the lateral epicondyle) gives instant relief and allows therapy to begin.

Exercises to improve wrist flexibility and increase the wrist flexor and extensor muscle strength must then be started as these are part of the initial problem.

A further 1-2 injections may be given if the symptoms recur.

A number of bands and devices are available to place round the forearm. These aim to "offload" the insertion of the extensor muscles into the lateral epicondyle. They are not a substitute for therapy but do provide symptomatic relief.

Alternative Treatment

ACTIVATED PLATELETS

A newer treatment is offered by the LONDON SHOULDER PARTNERSHIP.

A small amount of blood is taken from the arm and spun in a centrifuge. This concentrates the active components of the blood (1-2ml) which are then extracted and injected into the affected area under ultrasound guidance.

These active components (Growth factors) then support healing of the damaged tendon.

Arthrex ACP Sysytem

 

Ultrasound Guided ACP injection

If initial treatment doesn't work, what's next?

If injections and therapy fail to settle the symptoms then surgery may be required to excise the scar tissue over the lateral epicondyle.

Lateral epicondyle release.

How can further injury be prevented?

  • Keep the wrist and elbow supple
  • Keep the flexor and extensor muscles strong
  • Have sports equipment checked to ensure that the grip is appropriate for the hand size
  • Do not suddenly increase the demands on the area (i.e. build up to sports and no sudden weekends of heavy manual labour)
  • Be aware of any pain, stop the activity and apply RICE.