Common Conditions of the Elbow
Tennis Elbow
(Lateral Epicondylitis)
This condition is classically seen in tennis players although is common
in golfers or anyone who has undertaken unnacustomed heavy manual work
which involves a lot of lifting and carrying
What are the signs and symptoms?
Pain is felt over the outside of the elbow joint. A small area (the
lateral epicondyle) is
usually exquisitely tender. The pain may spread down into the forearm.
Gripping and carrying make the pain worse.
How is the diagnosis made?
The doctor will listen to the description of events and examine the
elbow. X-Rays will also be taken to determine whether there is a piece
of bone involved. Usually no further investigation is needed although
sometimes, in difficult cases, ultrasound or MRI may be helpful.
What is the initial treatment?
Firstly it is important to determine why the condition occurred so that
recurrence may be avoided. If it is sports related the equipment or
grip must be altered. Often the raquet handle is too small or too big
for the hand.
An injection of local anaesthetic and steroid into the most tender spot
(the lateral epicondyle) gives instant relief and allows therapy to
begin.
Exercises to improve wrist flexibility and increase the wrist flexor
and extensor muscle strength must then be started as these are part
of the initial problem.
A further 1-2 injections may be given if the symptoms recur.
A number of bands and devices are available to place round the forearm.
These aim to "offload" the insertion of the extensor muscles
into the lateral epicondyle. They are not a substitute for therapy but
do provide symptomatic relief.
If initial treatment doesn't work, what's next?
If injections and therapy fail to settle the symptoms then surgery may
be required to excise the scar tissue over the lateral epicondyle.
Lateral epicondyle release.
How can further injury be prevented?
Keep the wrist and elbow supple
Keep the flexor and extensor muscles strong
Have sports equipment checked to ensure that the grip is appropriate
for the hand size
Do not suddenly increase the demands on the area (i.e. build up to sports
and no sudden weekends of heavy manual labour)
Be aware of any pain, stop the activity and apply RICE.
