Tennis elbow may also be referred to as lateral epicondylitis. It causes pain on the outside of your elbow. This pain is made worse in several situations:
People also notice a tender spot around the outside of the elbow, usually around the prominent part of bone known as the lateral epicondyle, although for some people, the spot is a little further toward the hand. The muscles responsible to straightening your fingers and cocking your wrist back attach to the lateral epicondyle, and it is thought that repetitive strain to these muscles that cause tennis elbow.
Anyone can get tennis elbow, including Mr. Davies who actually got it from playing squash! Although it is called ‘tennis elbow’, most people do not get it from playing tennis! It is most common in people who make repetitive wrist movements as part of their job, such as painters and carpenters. This overuse of the muscles is thought to cause tiny areas of damage in the tendons that straighten your wrist and fingers which are not given a chance to heal properly.
Another form of tennis elbow, called acute tennis elbow, may be caused by a sudden injury to the tendons. Sometimes, the muscles can even pull the tendon off the bone, causing a sudden and intense pain, with bruising and severe weakness. If this happens, it is important to see your doctor as early surgery to reattach the tendons may be beneficial.
By taking good care of your muscles, such as doing stretches, a good warm-up and warm-down, you can reduce the chance of getting tennis elbow. If you do repetitive hand and arm movements as part of your job, make sure you take regular breaks and avoid activities which you know bring on pain. Mr. Davies’s top tip (from personal experience) is to make sure you have a good quality grip on your racket. If it is too thin, you will be tempted to squeeze the grip too hard, increasing your chance of tennis elbow. If necessary, you can put two cushioned grips on top of each other to increase the thickness of the grip.
This starts with a conversation with your doctor to describe the problems you are experiencing with your elbow. You will then be examined, with some specialised tests, paying careful attention to where the pain is coming from. The diagnosis is usually clear by this point. If there is any suspicion that the pain is instead due to arthritis around the outside of your elbow, you may be sent for an X-ray. If there is any doubt, or initial treatments have not worked, you may be sent for an MRI scan to look in more detail at the area.
For some people, just knowing what the problem is, and having the reassurance that there is no major damage to the elbow is enough. The pain can be controlled with simple painkillers, such as paracetamol and anti-inflammatories (if you can take them). This may be coupled with simple changes to your lifestyle to rest your elbow while it recovers.
Most people make a full recovery within a year.
There are several commercially-available clasps for tennis elbow. These are usually straps or plastic clips that go around your elbow near the source of pain. They put gentle pressure on the tendons in your forearm. Some people find these very beneficial at relieving the pain in your elbow. There are relatively inexpensive and safe treatments and, although they do not work for everyone, they are often worth a try.
A course of physiotherapy is the first line of treatment that most people are offered. The goal of physiotherapy is to stimulate the tendon to heal by itself, without causing further damage. The main exercises for tennis elbow are controlled stretching exercises. Your physiotherapist will show you these. It is normal for these exercises to be painful and you may need to build up from doing the exercises only once every 2-3 days to eventually doing them 3 times per day. It can take several months to get the full benefit of physiotherapy, so it is important to work hard early on, even if you do not feel an immediate benefit.
Another effective treatment is a PRP injection. PRP stands for Platelet-rich plasma. This involves taking some blood from your arm and putting it into a machine that separates the liquid and different types of cells in your blood. Special cells called platelets are then extracted from this mixture and injected around the painful area in your tendon. These platelets contain important proteins that stimulate healing and are thought to kick-start the healing process. It is important to rest your elbow for a few weeks after the injection and avoid anti-inflammatory drugs for 4 weeks to allow the healing process to start.
It can take up to 3 months to improve after this injection, and it is important to continue with the physiotherapy during this period. At least 50% of people notice a marked improvement, although many still have a tender spot on the bone which does not fully resolve.
Very occasionally for tennis elbow, you may be offered a low-dose steroid injection into the painful area. This is sometimes referred to as a cortisone injection. Although this can bring about rapid relief of the pain, its effect is not always permanent. Mr. Davies prefers to avoid steroid injections for tennis elbow because they can make it even more difficult to permanently rid you of the pain. They may be thought of as "short-term gain for long-term pain".
The purpose of this injection is to settle down any inflammation in your tendon. It is important that you start physiotherapy straight away after an injection. There are several rare risks of steroid injections:
If the above treatments are not successful, surgery may be helpful to treat tennis elbow. This is usually performed through a 3-4cm cut around the outside of your elbow and is often called a tennis elbow release. It involves removing any unhealthy tendon tissue and releasing a little bit of the tendon from the bone to reduce the tension on the muscle. Around 80% of patients report 80% relief from this operation.
Most people make a full recovery within a year. Around 80% of patients report 80% relief from surgery. It can take up to 3 months to improve after a PRP injection.