Pain over the bony prominence on the outer aspect of the elbow. This prominence (epicondyle) serves as the attachment for the muscles in the forearm that allow the wrist to be bent back and the fingers to be straightened.
The condition is also referred to as Lateral Epicondylitis. However this is misleading, as the pain does not result from true inflammation. Importantly, you do not have to play tennis to have the condition! In fact many patients we see have never even picked up a racquet or
play sport!
Golfers Elbow is exactly the same as tennis elbow but is on the inside of the elbow as opposed to the outside. Hence the information below applies exactly the same as Tennis Elbow.
Although the cause of this condition is unclear, it is believed that it results from repeated tearing of the tendon (ECRB) followed by a failure of this to repair completely. The problem is often seen in manual workers and other occupations and hobbies that involve repetitive wrist extension.
The primary problem in this condition is pain over the bony prominence on the outer aspect of the elbow but the pain can travel down the forearm. It tends to affect the dominant side more often and can make it difficult to move the elbow when the pain is particularly severe. People generally report pain over the outside of the elbow which at the start is mainly made worse by physical activity. As the condition becomes more progressive the pain can be present at rest.
Once you come to clinic a detailed history and examination is generally enough to establish the diagnosis. You may however be sent for either an ultrasound or MRI scan to assess the severity of the condition or when the diagnosis is unclear.
Non-operative
Most cases will settle without surgery but can in some cases take up to 12-24 months to achieve complete improvement. The first line of treatment is comprehensive physiotherapy exercise targeted to Tennis Elbow. Avoidance of activities that bring on the pain is important to prevent further exacerbation of the condition. This is usually in combination with simple pain killers and a wrist splint to rest the muscles that are damaged.
Physiotherapy
Most patients find their pain settles with physiotherapy alone. Research shows physiotherapy is the most effective treatment modality if adhered to for a minimum of 6 months.
Steroid Injection
On occasion a steroid injection can be given, however this is only after a minimum of 6 months of physiotherapy. A steroid injection is useful if you have a major life event coming up such as a wedding or a ‘holiday of a lifetime’. Research shows that whilst an injection can help the pain for a short time, the pain generally returns and the conditions last even longer.
If you have tried focused physiotherapy led rehabilitation and an injection and the pain still continues you maybe a candidate for an operation.
An operation is only a last resort as is does not have the same success rate as most other operations in Orthopaedics. The operation is performed under a general anaesthetic and involves the removal of the unhealthy tendon tissue. By removing the source of the pain and causing bleeding in the surrounding bone, the remaining tendon can heal back to the bone allowing the pain to settle. The operation cures the pain completely in approximately 60-70% of patients. It can however take up to 6 months to notice a significant improvement in your pain and up to 18 months before you completely recover from the surgery.
Aftercare
It is normally safe to drive within 6-7 days of your operation but can take up to 2 weeks before you are completely comfortable to start driving.
This depends on the intensity of the sport and can range from 6 weeks to 3 months off.
Like with any surgery there are a number of small risks associated with this operation.
Infection
(1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.
Swelling and Stiffness
Can remain for many months following surgery. It is important to elevate the limb and keep all joints that are not immobilised with a splint or dressing, active.
Nerve Injury
Is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome.
Recurrence
Is an unusual complication. You may however find that the symptoms recur some time after the original operation having completely settled initially. In this rare event a second operation may be necessary.
Complex Regional Pain Syndrome
Is an extremely rare (1%) complication that can follow any injury or surgery to a limb. In this situation the nerves in the arm over-react to the point where the hand becomes very painful, swollen and sensitive. This condition does improve with time but can be problematic for many months (see section on Complex Regional Pain Syndrome).
