Tennis Elbow

Tennis elbow is typically caused by the motion of a tennis back stroke. The muscle of the forearm becomes inflamed and injured from overuse (usually from improper technique) and small to large tears can form in tendon fibres that attach the muscle to the elbow, causing pain and swelling.

Risk factors for tennis elbow

Factors that put you at risk of developing tennis elbow include:

• Occupation – Those whose work requires regular repetitive movements of the arms and wrists are at a high risk of developing tennis elbow. Painters, carpenters, plumbers, cooks, and butchers are prone to tennis elbow.
• Age – Tennis elbow is a condition common in people between 30 – 50 years old.
• Hobbies – Those who are active in racquet sports like tennis, squash or badminton have a greater risk of tennis elbow, especially if they do not practise proper stroke techniques.

The symptoms of tennis elbow are similar to those of golfer’s elbow, except that tennis elbow causes pain on the outside of the elbow. Other symptoms include:

• Pain spreading down your arm towards your wrist
• Pain on the outside of the upper forearm, below the elbow
• Pain when bending the arm
• Pain when writing
• Pain when gripping or holding objects
• Pain when twisting the forearm
• Pain when fully extending your arm

To diagnose your condition, the doctor will ask about your symptoms and conduct a physical exam. You will be asked to move your fingers, wrist and elbow in different ways during the exam. Your doctor will also apply pressure to the affected areas to check for pain.

Generally, a physical exam and review of your medical history are enough to help your doctor make a diagnosis. However, there are some cases when the doctor needs to further investigate your condition through the following diagnostic tests:

• X-ray – This test may not be necessary for patients without history of inflammatory disease or trauma. While X-rays are not necessary in diagnosing trigger finger, hand X-ray is recommended if your doctor suspects abnormal pathology.

Tennis elbow can resolve on its own with some self-care measures and pain relief medications. Depending on the severity of your condition, your doctor may recommend the following treatments for tennis elbow:

Non-surgical treatments

• Pain medication – Your doctor will give you non-steroidal anti-inflammatory drugs to reduce pain and swelling.
• A brace centred over the back of your forearm, which may help to relieve symptoms by resting the muscles and tendons.
• Injections – Steroid injections may be given if other treatments are not successful
• Ultrasonic tenotomy (TENEX) – This is a non-surgical procedure that removes the damaged tissue on the tendons. In this procedure, the doctor will insert a special needle into the damaged part of the tendon. Ultrasonic energy will liquefy the damaged tissue, which the doctor will suction out.

Surgical treatments

If there is no improvement in your condition after 6 – 12 months of non-surgical treatments, your doctor may recommend surgery to remove the damaged tendon.

• Open surgery – The surgeon will make a cut above the bone on the side of your elbow and remove the damaged piece of tendon.
• Arthroscopic (minimally invasive surgery) – Few tiny cuts will be made on the skin over your elbow. Small instruments and a camera will be inserted into the holes to guide the surgeon in removing the damaged parts of the tendon.

Rehabilitative

• Therapy – Physical therapy sessions will help to stretch and strengthen your forearm muscles through certain exercises.
• Wrist-stretching exercises
• Checking your racquet for correct fit to prevent symptoms from recurring
• Rest with no sports or heavy work activities for several weeks

At Gleneagles Hospital, our experienced orthopaedic consultants and surgeons are supported by a comprehensive team of nurses and physiotherapists to provide you with the suitable treatment options.

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Most patients experience improvement and pain relief within 12 months of conservative treatment. However, there is still a risk of developing complications of tennis elbow such as:

• Chronic pain, if tennis elbow is left untreated
• Tendon rupture due to repeated steroid injections
• Recurrence of injury upon resuming normal activities