Tennis and golfer’s elbow (the scientific term is lateral and medial epicondylitis) are by far the commonest causes of pain around the elbow.
The pain, in fact, does not originate from the elbow joint itself, and most patients with these conditions do not play tennis or golf! I have recently seen an increase in these conditions in my clinic, probably because patients are spending more time working from home on their computers.
The cause is wear-and-tear or degeneration of the extensor tendons that originate from a bony prominence on the outside of the elbow in tennis elbow, and the flexor tendons on the inside of the elbow in golfer’s elbow.
Tennis elbow and golfer’s elbow may be acute and develop suddenly, for example, after a bout of unaccustomed wrist actions, or the pain may have set in over time and become chronic.
The patient typically describes pain over the outside (tennis elbow) or inside of the elbow (golfer’s elbow) with lifting or grasping.
The pain may radiate down the forearm. Commonly, there is weakness of grasp and grip normally due to pain inhibition and, in the later stages, there may be stiffness of the elbow.
The pain, in fact, does not originate from the elbow joint itself, and most patients with these conditions do not play either tennis or golf
The conditions are obvious clinically, and no investigations are routinely required. However, in dubious cases, an ultrasound of the elbow may help clinch the diagnosis of the two conditions.
Both conditions may be treated effectively using non-operative measures. Anti-inflammatory medications and creams may help when the condition is acute but normally fail to improve the chronic conditions.
An elbow clasp is a recommended way of treating both conditions. To be effective, the clasp must be very tight and, rather than being placed over the site of pain, it needs to be applied about 7.5cm down on the forearm. It works by removing the pulling on the tendons when the wrist or fingers are used and transferring the forces to the clasp.
The two types of injections that I use for these conditions are the steroid injections and PrP (platelet rich plasma). These may or may not work and, if they do work, their effect may be temporary. Having said this, injections for golfer’s elbow are not generally recommended as, in this case, the tendons are attached to the bone very close to an important nerve − the ulnar nerve − which does not tolerate injections well.
While in steroid injections, a mixture of local anaesthetic and steroid are used, PrP is a more biological injection. The blood derived from the patient is centrifuged and the plasma obtained, rich in growth factors and cytokines, is thought to help regenerate the chronic degenerate tissue.
The success rates from these injections is about 70 per cent.
Physiotherapy certainly has a role in the treatment of these conditions. Stretching of the tendons by pushing the wrist backwards and forwards (eccentric stretching) is thought to stimulate healing by improving blood supply. Occasionally, physiotherapists may recommend a course of ultrasound treatment.
In those patients where the condition is long standing, or in the case where non-operative treatments haven’t worked, surgery may then be an option. This operation is a minor procedure done as a day case under local or general anaesthetic. The aim of the operation is to clear off the degenerative tissue in the outside of the elbow in tennis elbow and inside of the elbow in golfer’s elbow and encourage bleeding. I also target the pain fibres around the area by ablating them. In this way, the success rate of the operation is 95 to 97 per cent.
Alistair Melvyn Pace, consultant orthopaedic surgeon