Tennis Elbow
Specialised care for complex joint issues
What is Tennis Elbow?
Tennis elbow, or lateral epicondylitis, is an overuse injury where tendons that fix to the lateral epicondyle (a bony part located on the elbow's outside) are inflamed.
Three bones join to create the elbow: the humerus (upper arm bone), radius (inner forearm bone) and ulna (outer forearm bone). Ligaments and muscles surround these bones, and a protective synovial membrane prevents arm friction by providing lubrication.
The elbow joint's complexity results in high movement abilities; however, forearm muscle stress and strain can cause elbow injury and inflammation. In turn, synovial tissue, tendons and muscles may become inflamed, causing pain.
Symptoms
Pain and tenderness of the outer elbow are very common symptoms of this condition. Symptoms may develop progressively or suddenly (such as after sporting activities or strenuous work).
Due to elbow weakness and pain caused by Tennis Elbow, the following activities may be challenging:
- Gripping objects (including pens)
- Shaking hands
- Turning doorknobs
- Holding cups
Pain from Tennis Elbow ranges from mild to severe, and may prevent you from sleeping. See your GP as soon as possible if you are struggling to move your elbow, have intense pain, or are experiencing numbness in the elbow, hand or arm.
Causes of Tennis Elbow
Injuries caused by muscle strain and overuse can also lead to Tennis Elbow. Many individuals involved in sports that involve frequent forearm muscle contractions (such as tennis) experience Tennis Elbow. However, this elbow condition can also be age-related. This condition often causes painful elbow function, and tendon changes may progressively result in the extensor tendon tearing at its origin.
Activities that increase the risk of Tennis Elbow development include tennis, typing, gardening, playing musical instruments, knitting and painting. Individuals with Tennis Elbow are generally between 35 and 55 years old; however, this condition can be experienced by anyone who frequently uses their forearm tendons.
Diagnosing Tennis Elbow
Injury history and a physical examination are generally enough to diagnose Tennis Elbow. Your GP will assess elbow and wrist swelling, tenderness and inflammation, and your movement abilities will be tested to evaluate the severity of the condition.
X-rays may also be conducted to explore other possible causes of your symptoms (i.e., arthritis). Degenerative tendon changes may also be examined via an ultrasound or MRI.
Treatment
Non-Surgical Treatments for Tennis Elbow
If you have mild symptoms, Tennis Elbow can often be treated at home through conservative measures, including:
- Resting the arm and ceasing involvement in activities that worsen pain
- Immobilising the arm using a brace or splint to reduce tissue stress
- Place palm in the upwards direction when lifting objects to reduce forearm strain
- Reduce swelling by placing ice on the elbow
- Consuming anti-inflammatory medications available over-the-counter (including Ibuprofen)
- Completing light exercises designed to stretch the wrist and elbow, promoting healing
These non-surgical treatments relieve the symptoms of the majority of patients. However, if these measures have been ineffective after approximately 6 months, visit your GP and request a referral to Dr Oscar Brumby-Rendell.
Steroid or Therapeutic Injections For Tennis Elbow
Therapeutic injections, such as steroid injections, may be recommended by Dr Brumby-Rendell, depending on the severity of your condition. Steroids (including cortisone) are anti-inflammatory medicines that can effectively reduce symptoms when administered into the affected area.
The injection is administered with the guidance of imaging (i.e., an ultrasound), which allows the medication to enter the correct location. As it contains anaesthetic, the injection is less painful; however, mild discomfort may be experienced as the injection is administered, and swelling and redness may arise.
Post-injection, the area must be protected and forceful arm motion avoided for a few days.
There are some risks associated with therapeutic injections, and as such, this medication may not be the best option for all patients. Your suitability for therapeutic injections will be assessed by Dr Brumby-Rendell, and you will be referred for this procedure if he deems the treatment suitable.
Surgical Treatment: Arthroscopic Surgery for Tennis Elbow
Surgery may be recommended by Dr Brumby-Rendell if your symptoms remain after a prolonged period or if your condition brings you severe pain and interferes with your daily life.
The damaged tendon is addressed in surgery. This may constitute the reparation or reattachment of tears, cutting the tendon, and/or removing bone spurs or tissue causing symptoms.
Open surgical release is the standard surgery that treats Tennis Elbow. However, Dr Brumby-Rendell implements arthroscopic (keyhole) techniques, as they bring many advantages that open release methods do not offer.
The advantages of arthroscopy, commonly known as keyhole surgery
- Reduced pain after surgery
- Quicker healing periods
- Decreased likelihood of infection
- Minimised trauma to soft tissue
- Faster recommencement of everyday life
Elbow arthroscopy also allows Dr Brumby-Rendell to view the elbow joint's inside and identify and treat other elbow conditions. This cannot be done with open surgical release methods.
The most important difference between the two surgeries is that multiple tendons must be released in open surgery, whereas only the affected tendon is released in arthroscopy. This reduces post-operation weakness and leads to an earlier recommencement of sporting activities.
Long-term outcomes of elbow arthroscopy
The long-term outcomes of this surgery will be discussed with you during your pre- and post-operation appointments with Dr Brumby-Rendell. Elbow arthroscopy has an excellent prognosis. Your individual recovery journey may be influenced by your injury's severity, the specifics of your surgery, and your obedience to post-surgery recommendations made by medical staff.
About Tennis Surgery Surgery
Dr Brumby Rendell conducts this surgery at a South Australian hospital. You will be under general anaesthetic. Firstly, Dr Brumby-Rendell will create small incisions around the elbow joint, and a small camera lens will be inserted into the joint. This allows the inside of your joint to be displayed on a screen, and Dr Brumby-Rendell can view the surgical site without creating a large open wound.
Dr Brumby-Rendell will evaluate the injury location and insert small surgical instruments into a few incisions surrounding your elbow. To reduce bleeding and increase site clarity, the area is flushed with a sterile liquid. This enables Dr Brumby-Rendell to accurately direct the surgical equipment to resolve your condition. Depending on the pathology, Dr Brumby-Rendell will either remove or repair your damaged tissue. Bone spurs and loose cartilage are also removed in this surgery.
When the procedure is complete, the surgical instruments are removed, the incisions stitched shut, and a dressing applied. This surgery takes approximately 30 to 45 minutes; however, you will generally remain in the recovery room for the whole day.
Click here to learn more about how to prepare for your surgery.
Recovery Time
You will not be required to wear a sling or splint post-surgery. These immobilisation devices may result in elbow stiffness and are, therefore, not recommended.
For a few weeks post-surgery, your elbow may feel sore. To reduce discomfort and inflammation, consume pain relievers and apply ice to the affected site.
You are permitted to stretch and gently move your elbow after surgery. You will be provided with an advised physical therapy exercise plan by Dr Brumby-Rendell, which aims to increase elbow and muscle strength.
It is important that you discuss a return-to-work plan with your employer, as you may have to complete lighter activities as you recover from your surgery (generally a few weeks).
It may take a few months to return to intense exercise, heaving lifting and sports. As all recovery journeys are different, your progress will be monitored by Dr Brumby-Rendell, and advice will be given during your check-ups.
Once you have a referral…
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