You can't remember the last time you picked up a racquet and yet somehow you've developed "Tennis Elbow".
The reality is this very common, painful, the condition has little to do with playing racquet sports and can affect any one of us. Read on to find out about tennis elbow, how it's diagnosed and how it can be treated.
What is tennis elbow?
Tennis elbow, also known as lateral epicondylitis, is a painful, non-inflammatory, degenerative condition of the tendon that attach the forearm muscles to the outside aspect of the elbow joint (lateral epicondyle). Because these muscles are heavily used when playing racquet sports the condition is frequently seen in tennis players which is where it gets its name from.
What causes tennis elbow?
Tennis elbow is a common condition that affects about 1-3% of the population every year.
Although playing tennis can lead to getting the painful condition only 5% of tennis elbow cases are caused by the sport. More commonly it is caused by repetitive strain from overuse doing activities such as lifting weights, pushing heavy objects, using hand tools, driving long distances, or working overhead for extended periods of time.
In recent times, a common cause is through prolonged use of a mouse and keyboard hence we see it often in office workers and serious video gamers with high actions per minute numbers (APM).
What are the symptoms of tennis elbow?
You may get pain along the outer aspect of your elbow where the (extensor) tendons meet the bone. It may feel like a dull, throbbing, pulling pain most times, but can then be sharp when you try to use it. You may find actions like giving a firm handshake, pulling a heavy door or simply lifting a kettle can become quite unbearable.
Pain spreading down the forearm is commonly reported.
A number of conditions can present like tennis elbow so if you have symptoms it is important you see an experienced clinician to confirm the diagnosis.
How is tennis elbow diagnosed?
Your elbow is examined and you will be asked about any symptoms you are experiencing. Diagnosis is usually confirmed with an ultrasound scan done on the same day of your appointment.
X-rays may be arranged if there is suspicion of an underlying bone or joint problem. Magnetic Resonance Imaging (MRI) is usually reserved for cases that have so far failed to respond to non-surgical treatment.
How do you treat tennis elbow?
Tennis elbow is a self-limiting condition, meaning the vast majority of people will get better without medical intervention. But, there are treatments that can improve your symptoms and speed up your recovery:
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Activity modification
The first step is rest, meaning avoiding activities that worsen your symptoms. This allows the body's natural healing process to take place before starting physical therapy.
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Physical therapy/physiotherapy
Stretching exercises and massage techniques can relax tight muscles and decrease tension.
Strengthening exercises can build strength and endurance. Ice packs wrapped around the affected area for 20 minutes at least 3 times daily can help reduce pain. A counterforce/elbow brace can also help reduce tension in the painful area.
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Medication
Various medications can be prescribed to combat the symptoms of tennis elbow. Anti-inflammatory medications work best when taken early in the course of the problem.
You should always ask your doctor before starting a regular course of medication.
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Dry-needling, autologous blood or platelet rich plasma injections (PRP)
This process involves passing a needle through the injured tendon whilst injecting a sample of your own unprocessed (autologous) or processed (PRP) blood into the injured tissue to encourage the body's own healing response. Studies have shown that autologous blood and PRP are not superior to simply making multiple passes with a needle through the tendon (dry-needling) which is why this is usually the first offered intervention.
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Extracorporeal shock wave therapy
Sound waves are used to break up scar tissue, reduce pain and promote local healing.
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Corticosteroid injection (CSI)
Commonly referred to as cortisone, CSI around the injured tendon can temporarily give immediate relief. However, the high risk of recurrent symptoms after treatment (as high as 50% vs 12% for placebo) means that steroid injections have fallen out of favour as a first-line injection treatment and are now given on a per/patient basis.
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Surgical treatment
Surgery for tennis elbow is rarely needed unless we (you have a say) feel you have exhausted all conservative/non-operative measures. Surgery involves cutting away damaged parts of the tendon and releasing tension so that new healthy tissue grows back.
There is no one cure for tennis elbow. People will respond differently to the various treatments, so, it is important to apply as many different approaches as possible.
How long can tennis elbow last?
Tennis elbow can last anywhere between 6 months - 2 years, but a full recovery is made within a year in 9 out of 10 cases. That is if appropriate action is taken and adhered to.
Are you worried about your tennis elbow and want to speak to an expert?
Click here to schedule an appointment with Dr Ade.
