Tennis elbow is a painful condition affecting the outside part of the elbow joint. It is common in athletes but also affects ordinary people who perform repetitive elbow activities. Generally, a tennis elbow injection of cortisone is not always the best first option. So, when should you consider an injection for tennis elbow?
Tennis elbow symptoms
The most common symptoms of tennis elbow include:
- aching pain on the outside of the elbow made worse by lifting or playing sport
- pain can move to the forearm and sometimes into the hand
- weakness in the strength of the arm and hand
Pain can occur gradually or suddenly. Moreover, intensity can range from mild to severe and debilitating.
Diagnosis of tennis elbow
Often, a thorough medical history and examination is needed to confirm the diagnosis and rule out other causes.
Apart from asking about the pain, your doctor will also ask about risk factors such as a change in sport or medical problems such as diabetes or rheumatoid arthritis.
Often, there will be tenderness on the outside of the elbow and pain with resisted activities such as wrist extension.
Tests for tennis elbow
Although tennis elbow is easy to diagnose, we sometimes use tests to help us make sure we get the correct diagnosis.
Either ultrasound or MRI will show degenerative changes in the collagen fibres confirming tennis elbow. Also, imaging can rule out other causes including ligament damage, joint degeneration, and a pinched nerve.
What is the most effective treatment for tennis elbow?
Generally, tennis elbow will settle with an exercise program supervised by a therapist. Examples of simple treatment include exercises to strengthen the forearm and elbow and stretching of the muscles and nerves in the forearm. Also, strengthening the shoulder, upper back, and lower legs is important to correct weakness in other parts of the body.
A tennis elbow brace can reduce pain and improve the outcomes of physical therapy.
Most cases improve after 6-12 months. However, we know that a few people do not settle with exercise and need other treatments.
Does a tennis elbow injection of cortisone help?
Previously, cortisone injections have been given to patients with troublesome pain. However, recent studies suggest that cortisone may not be good for patients with tennis elbow. In a recent paper written by Dr Masci, there is good evidence to suggest that cortisone is not great for this tennis elbow. While patients get short-term relief of up to 6 weeks with cortisone, they often do worse after 3 months. Also, we know that many people develop a re-flare after a cortisone injection. Overall, it would seem that a cortisone injection for this condition sets patients back rather than forwards.
If cortisone is not good for tendons, then what are the other options?
Fortunately, other treatments might help.
There is some evidence that shockwave can help. Shockwave produces soundwaves that cause remodeling of the tendon. Evidence is mixed regarding effectiveness in tennis elbow. Usually, 3- 5 sessions are recommended.
Glyceryl trinitrate patches for tennis elbow
Recent studies suggest that using a GTN patch can improve pain. We place these patches on the skin directly on top of the sore tennis elbow tendon. Patches should be put on in the morning and taken off at night. Side effects include headaches and skin rash. Generally, we suggest a trial for 2-3 months in connection with exercise therapy.
PRP injection for tennis elbow
Other injection options such as dextrose, PRP (platelet-rich plasma), or needle tenotomy may help.
In a recent study that compared injection therapy in tennis elbow, needle tenotomy was found to be the most effective in the short term.
Other studies have shown that PRP injections are better than cortisone. We obtain PRP from whole blood. The blood is spun in a centrifuge and the plasma (containing high amounts of platelets) is separated from the red cells and injected into the degenerative tendons.
Overall, injections should be done under ultrasound guidance to improve accuracy and avoid damage to other important structures in the elbow.
Finally, you should avoid surgery as studies suggest operations are not effective. A recent study showed that surgery was no better than sham surgery in tennis elbow.
For troublesome tennis elbow, could there be another cause?
Possibly. Some cases of persistent tennis elbow could be caused by elbow instability. Sometimes, instability occurs after a fall that leads to a ligament rupture. This ligament rupture leads to subtle instability and persistent lateral elbow pain.
Also, Golfer’s elbow is a similar tendon injury but occurs on the inside of the elbow.
Final word from Sportdoctorlondon about tennis elbow
Generally, we tell people with tennis elbow to be patient. Most cases will settle with simple treatments such as exercise. However, in more difficult cases, we use shockwave or GTN patches first followed by injections. Our preferred injection option is needle tenotomy followed by PRP. in almost all cases, you should avoid a cortisone injection.
Other elbow and hand conditions: