Tennis Elbow (Lateral epicondylitis)

What is Tennis Elbow?

Tennis elbow, also known as lateral epicondylitis is a common condition that causes pain on the outside (lateral side) of the elbow. It occurs after repetitive wrist extension, and is therefore often seen in office workers, manual workers and sportsmen. Part of the wrist extensor muscle insertion at the elbow becomes diseased. In most cases this will resolve spontaneously within 12 to 18 months. There are various options available to treat the pain associated with this condition.

Conservative treatment for Tennis Elbow

• Rest and ice packs during acutely painful episodes.
• Anti-inflammatory medication or ointments
• Physiotherapy
• Cortisone injections – provides good short term pain relief and improvement in grip strength
• Platelet-rich plasma injection: this implies injecting part of your own blood after spinning it in a special machine to isolate the plasma which is rich in growth factors. This is quite costly.
• Bracing of the wrist and elbow ?? – very limited evidence to support its use
• Shock wave therapy ?? – several systematic reviews did not find it useful in tennis elbow
• Laser therapy?? – conflicting evidence to support its use in tennis elbow

Surgical management of Tennis Elbow

When conservative treatment fails, surgery can be considered. An open procedure is performed in most cases. A small incision is made over the outside part of the elbow and the diseased part of the tendon is located and removed. Any abnormal hard bone or bone overgrowth is removed and a few tiny holes may be drilled into the bone to facilitate healing. The remainder of the unaffected extensor muscle origin is repaired. The skin is closed with dissolvable sutures and a bulky dressing is applied. Key hole surgery is another option to remove the diseased part of the tendon and will be considered if additional pathology is suspected within the elbow joint. A wrist brace following surgery is optional.

Rehab Protocol – Tennis Elbow Debridement

First 2 weeks

Keep the arm elevated initially and apply ice packs to control the swelling for up to 20 minutes at a time, three times daily. The bandage and padded dressing can be removed after 2 days while leaving the wound dressing (plaster) on. Start active assisted range of motion as soon as pain allows: Hold the hand of the operated arm with your unaffected hand and try to bend and straighten the elbow gently. Progress to active movements when pain allows. Start using the arm during activities of daily living, but avoid activities that cause pain. Remove the sling and wrist brace when pain allows, but wear the sling when going outdoors. Dr. Grey will see you again at 2 weeks for a wound review.

2 – 6 weeks

Continue with active range of motion exercises of the wrist, elbow, and shoulder. Patients doing sedentary work can return to work at 2 weeks, but manual workers should only do light duty at this stage. Patients can normally start driving at about 3 weeks, provided they can use the operated arm comfortably and be in full control of the car. Another follow-up visit is scheduled at 6 weeks.

After 6 weeks

Strengthening is started at this time. Start with light weight exercises and gradually progress to heavier weights as pain allows. Manual laborers can return to normal duty. Sportsmen can start with sports specific exercises under the guidance of the physiotherapist and aim to return to sports by 8 weeks.

Orthopedic Elbow Surgeon

Dr Grey is a specialist elbow surgeon and will advise patients with the correct treatment necessary.