Tennis Elbow aka Lateral Epicondyliitis
Tennis elbow (aka Lateral Epicondylitis) is a condition which causes pain over the outside (lateral surface) of the elbow. It usually effects adults, and is caused by a degeneration of a tendon around the elbow (the Extenso Carpi Radialis Brevis tendon or ECRB). It is not an inflammatory condition, and is moreso related to the fact that tendons have a poor blood supply- as a result tears in tendons have a much poorer ability to heal compared with other tissues e.g. muscles.
Tennis elbow can occur in anyone but is more common in people who perform repetitive wrist or elbow activities, particularly, as the name suggests, in tennis players because of the backhand stroke.
Most people with tennis elbow get better without an operation. It can take up to a year for the pain to improve. There are numerous treatments which can be tried to help improve the pain during this period. These include:
Modification or avoiding the activities which make the pain worse.
Braces: e.g Counterforce Brace (Fig 1)- this works by relieving some of the force put through the degenerate part of the tendon. These braces can be ordered through the OPC website.
Autologous blood injections (ABI) or Platelet Rich Plasma (PRP) injections. ABI involves withdrawing the patient's own blood from the other arm, and injecting it into the diseased tendon. PRP involves the same process but the blood is "spun down" to allow a concentrated injection of the substances in blood which will help to effect healing (hormones and cytokines). More information on this process can be found at this website.
Active Release Therapy: This is a form of physiotherapy which involves firm massage of the painful area to stimulate healing. It is painful during the actual massage but is usually followed by an improvement in the pain symptoms. It has been shown to be an effective form of therapy. More information on active release therapy can be found here.
There are a wide variety of other treatments described in the medical literature, all with varying results including cortisone injections, ultrasound, nitric oxide patches, acupuncture and lithotripsy.
As mentioned previously, most patients with tennis elbow will get better with time. Those patients who have not improved after a year of symptoms may be suitable for surgical treatment. Surgery involves cutting out the diseased / degenerate tendon, stimulating the normal tissue to heal and repairing the remaining tendon. In the appropriate patient group, surgery has a success rate of 95%.