Tennis elbow

What is Tennis elbow?
Tennis elbow is now a commonly known problem. It is generally an irritating pain occurring a the outer and inner edges of our elbow (lower part of the arm humerus) bone. One of our cricketing heroes had been disabled by it and finally was cured by surgery. 

Lateral epicondylitis is a painful condition on the outer aspect of the elbow resulting in pain in simple activities like lifting a jug or opeining a tap (commonly known as tennis elbow). A similar condition occurring on the inner side of the elbow is commonly known as golfer’s elbow.

Why does the pain occur in the elbows?
The explanation on why the pain occurs here is as follows: Our muscles are attached to bone via tendons. Tendons are cord like structure, which do not stretch. Therefore an abnormal high intensity force like serving in tennis, or a repetitive stress like hammering pulls at the bone-tendon junction due to concentration of forces here, causing inflammation and pain.

What are the symptoms?
The patient presents with complain of painful tenderness at the point on the elbow and sometimes the whole forearm during any activity like playing raquet games, golf, swimming, typing, working in the kitchen and even lifting light objects. Some people also present with elbow stiffness. 

How is it diagnosed?
After a clinical examination, the doctor may take x-rays of the elbow and certain blood tests to help confirm diagnois and rule out other problems of the elbow like collateral ligament strain of enthesitis. 

What is the treatment?
Once diagnosed treatment rests firstly in physical therapy, and elbow supports. The therapist guides the person with passive stretching exercises and various modalities of heat or cryotherapy. If the pain and discomfort refuses to go, the doctor often injects a local steroid at the point for stimulation a healing response. There are other scientifically proven methods of local injections preferred by different surgeons, but most of the time the injection helps in faster relief from the pain. 

In such a pain of high severity and long duration, the doctor may do a surgical release of the tendon which is primarily responsible. This is the tendon of the extensor carpi radialis brevis muscle. The release may be done by open surgery and more recently, without opening the joint, by arthroscopic surgery, which has also been done successfully at our hospital. Arthroscopic surgery involves visualising the entire elbow joint by an operating telescope, identifying the ECRB and releasing it. All this is done by 2 or 3 five millimetres cuts on the elbow joint and the patient may go home on the same day of surgery.

Usually this condition takes 8 to 12 weeks to heal, and one should start exercises and continue with therapy and medication at an early stage for a fast and early recovery.

Compiled by
Dr Pratip Mandal
Consultant Opthopaedician, Sports Medicine