Tennis Elbow

What is Tennis Elbow?

Also known as lateral epicondylitis, tennis elbow is a common and painful condition affecting the elbow, caused by micro-tearing of a group of tendons known as the common extensors.

These tendons originate on the outer part of the elbow, extending down the forearm to the wrist and fingers, and are responsible for wrist and finger extension. The ECRB (extensor carpi radialis brevis) tendon is commonly involved in tennis elbow.

What are the Causes?

Tennis elbow results from micro-tearing, often due to repetitive loading, of the common extensor tendons. Activities requiring forceful contraction of forearm muscles or repetitive wrist and finger extensions, such as playing tennis, pose a particular risk. Factors like high intensity and frequency of play, improper techniques or equipment, and muscle imbalance can contribute to tennis elbow. It is also prevalent in various professions like musicians, cooks, carpenters, butchers, and painters.

What are the Symptoms? 

Patients typically experience pain, aches, or a burning sensation over the outer part of the elbow or forearm. Symptoms worsen with gripping or forceful wrist extension against resistance, and some patients may present with weakness in grip strength.

How is it Diagnosed? 

Tennis elbow can be diagnosed by a doctor through symptom assessment and physical examination. In some cases, radiological imaging such as X-rays or MRI may be required.

What are the Treatments?

For many individuals, conservative treatments are the first line and suffice to manage tennis elbow effectively. These may include:

1. Rest and Activity Modification: Giving the affected arm adequate rest and avoiding activities that exacerbate symptoms.
2. Physical Therapy: Targeted exercises to strengthen and stretch the muscles and tendons of the forearm, as well as techniques to improve biomechanics and ergonomics.
3. Bracing or Splinting: Using braces or splints to provide support and reduce strain on the affected tendons.
4. Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, or other pain-relieving medications to alleviate discomfort and inflammation.

For chronic tennis elbow, your doctor might recommend shock wave therapy or injections with steroids or PRP (platelet-rich plasma).

Do I Need Surgery for Tennis Elbow? 

While conservative measures are successful for many patients, some individuals may find that their symptoms persist despite these interventions. In such cases, your orthopaedic doctor may recommend tennis elbow release surgery. This procedure is typically considered when:

• Symptoms persist for a significant duration despite conservative treatment.
• Pain and limited mobility significantly impair daily activities and quality of life.
• There is evidence of severe tendon damage or degeneration.

The Surgical Procedure:

Tennis elbow release surgery is usually performed on an outpatient basis under local anesthesia with sedation or general anesthesia. The procedure generally follows these steps:

1. Incision: The surgeon makes a small incision over the lateral epicondyle of the humerus, exposing the affected tendon.
2. Tendon Release: The surgeon carefully identifies the damaged portion of the tendon and releases/excises it from the underlying structures, including any scar tissue or adhesions.
3. Tendon Repair (Optional): In some cases, the surgeon may perform a tendon repair using techniques such as sutures or grafts to strengthen and support the tendon.
4. Closure: Once the necessary adjustments are made, the incision is closed with sutures or surgical staples, and a sterile dressing is applied.

Recovery and Rehabilitation:

Following tennis elbow release surgery, patients typically undergo a period of rehabilitation to optimize healing and restore function. This may involve:

• Immobilization: Initially, the arm may be immobilized for a short period with a splint or brace to protect the surgical site and facilitate healing.
• Physical Therapy: Gradual introduction of exercises to improve range of motion, strength, and flexibility in the affected arm.
• Activity Modification: Guidance on gradually resuming activities while avoiding overuse and repetitive motions.
• Pain Management: Medications and modalities to manage post-operative pain and inflammation.

Expected Outcomes:

Tennis elbow release surgery has a high success rate in relieving pain and restoring function for appropriately selected patients. Many individuals experience significant improvement in symptoms and are able to return to their desired activities with reduced or no pain. However, it's essential to follow post-operative instructions carefully and actively participate in rehabilitation to optimize outcomes.