Tennis elbow treatment

Tennis elbow (extensor tendinopathy)is a condition which gives rise to pain and weakness in the tendons in the elbow which attach the muscles of the forearm with the outer elbow bone (lateral epicondyle). It is often associated with increased periods of unaccustomed strenuous activity with the forearm muscles. 

Common examples may be an increase in computer use (especially if there is a poor ergonomic setup), DIY tasks involving gripping and twisting with the wrist/ hand and sometimes racket sports. Although rackets sports players can develop a common extensor tendinopathy, the vast majority of individuals who develop symptoms do so as a result of prolonged, repetitive activities including warehouse or desk-based work, often with a poor ergonomic setup.

Localised pain is felt directly over the common extensor tendon in the outer elbow which sometimes radiates down the forearm muscle bulk.

Symptoms are aggravated by any activity which requires repeated use of the wrist extensor muscles. Common examples may include working at a computer (keyboard or mouse work) or gripping, lifting or carrying tasks.

A common extensor tendinopathy can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition. In some circumstances it may be necessary to conduct a physical examination but this is usually not necessary in uncomplicated tennis elbow.

The main features are tenderness directly over the tendon insertion on the lateral bony point of the elbow. There is also pain directly over the tendon when contracting the forearm muscles against resistance (eg when gripping or resisting wrist extension).

Scans are not routinely required.

A common extensor tendinopathy can be managed effectively by adhering to the following advice and exercise routine.

Modifying aggravating activities. If there are some particularly stressful tasks such as DIY or racket sports which seem to be aggravating your symptoms, then the common extensor tendon may need 4-6 weeks of relative rest.

Ergonomic adjustments. If the condition has been triggered by repetitive computer work, changes to your overall sitting position to ensure a neutral elbow and wrist position as well as some specialist keyboard and mouse equipment can significantly reduce the stresses placed on the common extensor tendon:

Appropriate DSE set up

Exercises. Regular exercises to strengthen the wrist extensor muscles and tendon in the forearm and stretch the flexor muscles:

3×15 repetitions 3-4x per week

5×30 second holds, 2x per day

These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your GP or Physiotherapist.

Corticosteroid injection therapy. Evidence suggests that if possible, corticosteroid injections are best avoided as the steroid may weaken the tendon in the longer term. However, injections may be discussed with individuals who continue to suffer disabling pain (preventing work and leisure activities) and have failed physiotherapy management. You can read more about local corticosteroid injections here.

Your consultant will examine the elbow, and may use imaging technology to view the joint and rule out other causes of pain. You may be prescribed medication to treat the pain and inflammation. You will be required to rest your elbow and abstain from sports or heavy activities for a short time, and you may have to wear a splint to support your elbow.

You may be required to attend physiotherapy sessions which is often a very effective and evidenced based treatment for tennis elbow. Exercises involve gradually strengthening exercises for the forearm muscles which gradually increase the amount of load, thereby strengthening the affected tendon. 

In some cases, an operation will be required to release the inflamed tendon, debride it and repair where necessary.

Depending on the treatment required you should be able to return home the same day, but your recovery time is dependent on the severity of the injury. Your consultant will advise you and answer any questions you may have.

If a surgical release is considered, this is a generally safe procedure but there are some potential complications you should be aware of.  These affect a very small percentage of patients.

  • Infection can occur although our theatres have ultra-clean air operating conditions keeping infection rates to the minimum.
  • Blood clots are possible after any operation and are more common in patients with some pre-existing medical conditions. However, again they affect a very small percentage of patients and have well established treatments including aspirin.
  • Very rarely, damage to the nerves around the elbow leading to numbness, pain and in some cases weakness in the hand - this usually settles on its own. 
  • There may be continued pain in the elbow following the surgical release.

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Fast track your treatment

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01761 422 222

Circle Bath Hospital, Foxcote Avenue, Peasedown St John, Bath BA2 8SQ

Good

Overall rating 24th April 2017