Tennis Elbow
Surgery for tennis elbow, a type of elbow tendonitis, should be avoided as recent studies suggest surgery is no better than physiotherapy or sham surgery.
What is tennis elbow?
Tennis elbow, also known as lateral epicondylitis, is a common elbow tendonitis that affects the tendon attaching the muscles on the top of the forearm to the outside of the elbow. As the name suggests, tennis elbow is frequently associated with tennis players. However, it also appears in other sports or activities that stress the elbow, such as playing a musical instrument or using a hammer. Interestingly, a similar injury occurs inside the elbow, known as a golfer’s elbow.
What are the typical features of this elbow tendonitis?
Generally, you may notice pain on the outside of the elbow. Usually, pain occurs while lifting with your arm, gripping objects such as a cup, or rotating your forearm while turning a door handle. Typically, pain varies from a mild nuisance to severe pain that stops you from playing sports.
Obtaining imaging to confirm lateral epicondylitis and rule out other causes is essential in complex cases. We use ultrasound to visualise the typical tendon changes, including thickening and increased blood flow. Additionally, we can examine the elbow joint and surrounding nerves to rule out potential sources of pain.
Other potential causes of outer elbow pain include the following:
- Elbow Arthritis
- Snapping Triceps Syndrome
- Triceps Tendonitis
- Elbow Plica Syndrome
- Radial Tunnel Syndrome
- Radial Collateral Ligament Tear Elbow
- Referred Pain from the Cervical Spine
What is the treatment for this elbow tendonitis?
In most cases, elbow tendonitis typically improves with simple treatments. However, recent evidence suggests that physiotherapy is the most effective treatment for tennis elbow. Daily exercises using light weights to strengthen the forearm muscles are an effective way to do so. Additionally, nerve stretches and techniques to enhance neck mobility can improve outcomes. Improvements occur gradually over weeks to months. However, some cases fail to improve and require other treatments.
Dr Masci has expertise in treating complex cases of tennis elbow. He will assess your problem and use an ultrasound to confirm the diagnosis of tennis elbow. Finally, he will give recommendations on treatments. Other treatments, such as shockwave therapy, GTN patches, or injections, may be offered depending on the individual’s preference. For example, some want non-invasive therapies and are more likely to try GTN patches or shockwave. Alternatively, others prefer invasive treatments and will choose injections. Dr Masci has co-authored a study on ultrasound-guided injections for tendinopathy. In general, cortisone injections harm elbow tendonitis, meaning patients do worse than no treatment. One study found that patients who had a cortisone injection did worse at 12 months compared to those who received a placebo injection. There are no clear favourites for other injections, so we use the most suitable injection. However, recent evidence suggests that platelet-rich plasma or needle tenotomy are the preferred injections for lateral epicondylitis.
What about a tennis elbow tear?
Tennis elbow tear, also known as an Extensor Carpi Radialis tendon tear, is relatively common in longstanding cases of tennis elbow. Generally, these tears are small and located on the undersurface of the tendon near the radial collateral ligament. Unless the tear is full-thickness and retracted (which is rare), the treatment is the same as for tendonitis. There is no evidence to suggest that small tears require different treatments from regular tennis elbow tendonitis.
Sometimes, other structures outside the elbow are also torn. Tearing of the radial collateral ligament, which sits under the extensor tendon, can cause ongoing pain and instability of the elbow.
Final word from Sportdoctorlondon
Tennis Elbow is a common cause of elbow pain. Typical findings include pain with lifting, gripping, or turning, as well as tenderness at the tendon’s attachment to the outside of the elbow. Overall, simple treatments such as forearm strengthening exercises and nerve stretches work well. However, other therapies, such as GTN patches, shockwave therapy, or injections, should be reserved for use in complex cases. Finally, surgery should be avoided.