Elbow tendinopathies (tennis/golfer’s elbow)
The elbow is a hinge joint, connecting the upper arm and the forearm. It is a complex joint and damage or injury to it can be very painful as well as tremendously limiting. Not being able to move your arm without pain can seriously limit the day-to-day tasks and activities you’re able to carry out.
Your elbow joint has a number of tendons in it, and these tendons attach the muscles to the bones. If you overuse the elbow, it can be easy to damage the muscles that attach to the tendons, and this type of injury is most often seen in people with manual jobs where the forearms are used a lot; plumbers and electricians for example. However, I do also see it in office workers where repetitive work has triggered the problem.
Often, people don’t even realise they are overusing their elbow joint until they start to become aware of a general pain around it. As this pain develops, it may start to keep them awake at night and trying to stretch the elbow out can also be very painful. To try to reduce their pain, people stop moving their elbow as much, although this can lead to a reduction in their range of motion.
People commonly refer to this kind of damage as ‘golfer’s elbow’ or ‘tennis elbow’ (damage to the inside of the elbow is ‘golfer’s elbow’, to the outside it is ‘tennis elbow’). These names are mainly historical in nature and you don't necessarily have to play these sports to get the condition.
Diagnosis comes from both the medical history and a clinical examination. When you first come to see me, we will talk about your symptoms and how long you have had them. I will then have a thorough check of your elbow, moving it around in various ways to assess the extent of any damage to the muscles. An ultrasound or MRI scan will help to confirm the diagnosis, and these can both be easily arranged and carried out at Circle.
There are a number of non-surgical (conservative) treatments available, all of which may help. Certainly, conservative treatment should be tried before any surgery is considered and your GP may well have helped to arrange one of these already.
- Physiotherapy: expert guidance from a physiotherapist can sometimes help relieve pain in the joint.
- Steroid injections: an injection of a corticosteroid into the joint, this can help to relieve pain and reduce inflammation. The effects do wear off over time though, so it shouldn’t been seen as a permanent fix.
There are also a couple of newer conservative treatment options, both of which have shown good results:
- Shockwave therapy: This is a fairly recent treatment, introduced through sports medicine departments. In essence, this involves passing a pressure wave through the damaged tendons in order to generate a healing process.
- Blood plasma: A sample is taken of your blood, which is then spun to separate out the plasma. This plasma is then concentrated with all the chemical products that the body needs to repair injured areas and then injected into the painful tendons.
All of these treatment option have got published data to say that they work in some of their patients, and overall perhaps 50-60% of patients will get some relief through them. Where these treatments don’t help sufficiently – or they stop working as well - people will then tend to be referred to me for surgical treatment.
Surgery for this is carried out under general anaesthetic and involves releasing the tendons and reinserting them onto the bone. The operation takes 15-20 minutes and it is done as a day case, meaning you are able to go home the same day.
Recovery from this surgery is fairly quick and you will probably only need a couple of weeks off work. I always advise people not to perform any activities that they know aggravated the problem prior to their surgery for about 4-6 weeks. You will also have expert help and guidance from the Circle physiotherapy team to restore strength and function in the joint.
I will see you again in clinic about three months after your surgery, and at this stage I would expect you to be well on the road to recovery. From my own published data for this surgery, about 95% of people who had it are now doing well and are satisfied with the results. It is certainly a good operation to consider if the conservative measures have failed.
If you are struggling with pain in your elbow, why not arrange a visit with me? I will carry out a full and detailed examination and arrange any diagnostic tests needed to make an accurate diagnosis. If there are any treatments that would be helpful for you, whether conservative or surgical, I’ll talk with you about them so that you have all the information you need to make an informed choice.
I had previously suffered with tennis elbow in both my elbows, which eventually cleared up by itself. When I began to experience elbow pain again, I thought it was probably the same thing and would resolve itself. However, over a period of about 24 months, the pain became much worse. It became so bad that I couldn’t use my right hand for normal things and had to train myself to use my left hand instead. I wasn’t even able to open a door with my right hand.
My GP arranged for me to have a few injections into my elbow to try to help relieve the pain, but when they didn’t really help, I was advised to get specialist help. I was fortunate to be referred to Circle, where I met Andrew for a consultation.
Having experienced tennis elbow previously, it turned out that I now had golfer’s elbow (‘medial epicondylitis’). Andrew was incredibly polite, very informative and explained everything to me very clearly. He used a model of the elbow to talk me through exactly what the problem was, and how the different treatment options could help stop my pain and give me my function back in the right arm again.
As I had been struggling with the pain for such a long time, I knew that it was unlikely to go away by itself so decided to have surgery. This was simple to arrange, and I have to say that booking in to Circle on the day of the operation was exceptionally easy. The Circle staff took great care of both me and my husband, who had come with me.
Once Andrew had done the operation and I was awake again I could tell that the chronic pain had gone, just like that. It was amazing. Understandably I was sore from the surgery, but it was so much better than my previous pain. Once Andrew had checked everything was looking good, I was able to go home the same day, with my arm in a special sling for a few weeks. The painkillers I had been prescribed at Circle really were good and any pain was managed very well.
I had a couple of physiotherapy sessions two weeks later, to help me start getting my strength and mobility back. When you’re struggling with chronic pain and not moving your arm as much as normal, you don’t realise how much weaker your muscles become. Ice packs and plenty of rest also helped.
I am very grateful to Andrew for his help. My arm is now pretty much back to normal. Having trained myself to become left-handed as the pain in my right arm got worse, it is great being able to use my right arm once again!