Do I have Tennis Elbow?

What it Tennis Elbow?

Tennis elbow, or lateral epicondylitis, as medical professionals term it, is a chronic symptomatic degeneration of the common extensor tendon attachment of the forearm at

 their origin around the outer aspect of the elbow. It usually affects between 1% and 3% of the population between the ages of 35 to 55 years. It is usually self-limiting, only requiring simple analgesia in most cases.

The symptoms usually develop with excessive and repetitive activities that involve the forearm extensors. It is commonly associated with tennis, piano playing, and office workers who spend much of their day working on keyboards/ PC’s. Sometimes manual work like DIY- excessive use of the twisting motion used to drive in a screw, may result in symptoms.

Pain is felt over the outer/ lateral aspect of the elbow and may radiate down the forearm. This pain can be intermittent, or persistent affecting all daily activities, and may even be present at night in severe cases. Commonly, certain activity, like those mentioned above, may aggravate the symptoms. When examined by your doctor, full elbow range of movement is usually found, with point tenderness at the lateral epicondyle. Special tests are used to confirm the diagnosis by your doctor: 

• Resisted middle finger extension
• Resisted wrist extension with the elbow in full extension and pronation
• The “chair” test- picking up a chair with the forearm in pronation
• Diminished grip strength of the same hand

Should the same pain be reproduced in the same area during these provocative tests, it is almost guaranteed that tennis elbow is the diagnosis.

Most of the time, further imaging like x-rays and scans are not usually necessary, neither is it mandatory to perform blood tests. Uncommonly, x-rays may be of value, should your doctor suspect another cause, like elbow arthritis.

Treatment

Avoiding the activity which is causing the symptoms is usually a good start, together with simple analgesia. This is usually supplemented with bracing. Bracing most often involves elbow straps, or wrist extension braces, which reduce the level of tension in the forearm extensors. Bracing itself is followed by Physiotherapy. Your physiotherapist can assist by first stabilizing the shoulder- strengthening of the periscapular muscles, notably trapezius and serratus anterior, followed by closed chain exercises which will activate the rotator cuff muscles. Thereafter, exercises to improve range of movement, and eccentric strengthening exercises usually help. Acupuncture and laser therapy have shown to be of little use.

Treatment with anti-inflammatory medication and steroid injections are used very often. While slightly uncomfortable, special techniques to perform multiple punctures of the are during the steroid injection, have shown to be more effective. The reason for this, is thought to be twofold: first, the steroid itself help combat inflammation within the area, and secondly, the little bleeding produced by multiple passes of the needle, is thought to release special proteins from the blood which combat inflammation. 

Another treatment is called “PRP” injection. This is when your own blood is drawn, and then spun down in a powerful machine called a centrifuge, which separates the blood cells from the fluid- plasma. This plasma is rich in the protein from platelets, which combat inflammation, injury, and pain- Platelet Rich Plasma/ PRP’s.

Should symptoms persist in spite of the treatment methods mentioned above, your doctor may recommend surgery. The procedure involves making an incision into the attachment of Extensor Carpi Radialis Brevis muscle at the elbow, and removal of the inflammatory and degraded tissue underneath it’s origin. The procedure is relatively small, and is performed as a day case, without the need to stay in hospital overnight. Manual workers are advised to return to work at 6 to twelve weeks, but desk workers may return immediately, but will require modified duties and workstations, to enable recovery.