Tennis elbow is a common cause of elbow pain located on the outer aspect of the arm. The condition is caused by degeneration in the tendon that anchors the muscles of the lower arm that bend back your wrist and fingers to the outside of the elbow. The degeneration is usually due to repetitive overload of the tendon cells leading to cell death and replacement by scar (tendinopathy). The scar is periodically not able to stand the forces placed on the tendon resulting in pain. Under the microscope there is very little evidence of inflammation.
The pain may be constant or triggered by certain movements such as lifting, typing or screwing lids. The pain ceases in 90% of patients by 12 months after onset. It may recur with greater than normal activity.
- Activity Modification: activities that cause a flare in the pain should be restricted or temporarily omitted and gradually introduced. Workplace environments can be assessed by an occupational therapist to minimize tendon overload. This may involve adjustments to the workstation, rotating tasks and/or increasing break frequency. A tennis elbow (counterforce) brace is a non-expansile strap worn around the widest part of the forearm muscles. It can reduce pain by limiting the amount of muscle expansion and therefore force placed on the tendon
- Pain Management: may include:
- medications such simple pain killers and anti-inflammatories.
- Injection therapies such as corticosteroid or platelet rich plasma injections injection can provide relief. The response to these injections varies widely and it is difficult to predict who will benefit. Greater than three coticosteroid injections can cause damage to the tendon structure.
- ice and acupuncture can provide short term relief.
- Physiotherapy: can assist with forearm stretching programs, local pain management techniques and gradual strengthening of the associated muscle groups
Less than 10% of patients develop chronic pain with pain and disability lasting beyond 12 months. These patients can be considered for surgery. Surgery involves resection of the degenerate tendon and local healing stimulation by bone drilling. The surgery requires an anaesthetic, takes less than an hour and can be performed as a day surgical procedure. The surgery can be performed as an open or arthroscopic procedure. The surgery provides permanent relief of pain in approximately 75% of patients. The biggest risk is incomplete pain relief (25%).
Arthroscopic Tennis Elbow
Other techniques for treating tendinopathy include:
- Stimulating the tendon with ultrasound (ECSWT)
- Injecting the degenerate tendon with blood or growth factors
- Needling the tendon under ultrasound imaging.
These are yet to be proven in rigorous scientific studies and research continues for reliable techniques.