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Tennis Elbow

This is a condition affecting a group of tendons at the outer aspect of the elbow. This group of tendon is called common extensors and it is attached to a small bone on the side of elbow. Because of heavy and repetitive activity, there is micro damage to the tendon. This could be due to work or sports. The condition is generally seen during active working life. It is considered a self limiting condition and even without treatment there is usually a natural healing which resolves the condition but this could sometimes take a few years.

Symptoms

The main symptom is pain which is felt on the outer aspect of the elbow and extends to the back of the forearm sometimes up to the hand. Pain is worse during activity particularly one that requires strength such as lifting or turning the forearm. Straightening the elbow fully is also painful. Pain can be disabling and absences from work are common. There is usually no swelling or any external change on the skin surface.

Diagnosis

Diagnosis is not difficult and simple examination is sufficient. There is tenderness on the bone at the outer aspect of elbow. Pushing the hand backward against force is very painful. X-rays are usually not necessary but they are normal. Sometimes the condition can be mistaken with a trapped nerve (radial tunnel syndrome) and some joint damage in the elbow can also gives similar pain. In doubtful situation, x-rays and MRI scan is necessary to confirm the diagnosis.

Treatment

Non-surgical

Rest and anti-inflammatory medications are the first line of treatment. Physiotherapy such as massage, heat and passive stretching and later strengthening is also helpful. A support device such as epicondylar clasp helps to reduce the tension in tendon and reduces the pain.

Cortisone injection

Cortisone injections in the form of Depomedrone or Triamcinolone are another treatment method which is very effective. The injection is given with a local anaesthetic agent such as Lignocaine. The effect of injection may last for many months and it is hoped that by then the condition may have resolved itself. The injections can be repeated.

Surgical Treatment

If other methods have failed to relieve the pain then operation is the next option. Surgical treatment is release of the tendon. This works by reducing the tension in the tendon and also by starting a fresh healing response. Standard method of release is by an open operation on the outer aspect of the elbow. Releases can also be performed by key-hole method. There are some newer techniques recently described but their efficacy is not fully established. Surgical release has a success rate of around 85%. Recovery from the operation is quick but full benefit of the procedure is acquired sometimes after many months. The operation is done under regional or general anaesthesia as a day case surgery. Complications of surgery include infection and sometimes incomplete relief of pain. It is usually necessary to continue physiotherapy to achieve the full potential of the operation.

Nasser Hyder
FRCS (Trauma & Orth)
Consultant Trauma and Hand Surgeon

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Hand & Wrist Elbow After Care and Therapy