Golfers & Tennis Elbow.
Tennis Elbow, also known as lateral epicondylitis, is characterised by pain on the outside part of the elbow. The muscles, which attach here, pull the wrist upwards and are called extensor muscles. These muscles join together to form a common tendon, which attaches to the lateral epicondyle, and damage to this tendon causes pain.
Golfers elbow, also known as medial epicondylitis, is characterised by pain on the inside part of the elbow. The muscles, which attach here, pull the wrist downwards and are called flexor muscles. These muscles join together to form a common tendon, which attaches to the medial epicondyle, and damage to this tendon causes pain.
What causes Golfers & Tennis Elbow?
Despite the names these conditions are only rarely associated with golf and tennis! They are both very common in patients ages 30-50 who undertake repetitive or strenuous forearm activity. The actual cause is thought to be minor injury within the tendon; which then tries to heal. For reasons that are not understood this healing process gets switched off generating painful abnormal tissue in the tendon.
How is Golfers & Tennis Elbow diagnosed?
Usually Mr Moverley can diagnose golfers & tennis elbow with a combination of clinical examination and a careful history of your symptoms. There are several other conditions that can cause similar symptoms so getting the correct diagnosis is key to the success of treatment. Further diagnostic tests are used for confirmation and to plan treatment.
X-rays can be obtained on the day of your consultation and primarily are used to rule out other conditions such as arthritis
Ultrasound is useful as it can demonstrate inflammation in the tendon and perform dynamic assessment of both the tendon and nearby nerves.
MRI is most likely to be requested if your surgeon thinks you might have a tear in the tendon or a ligament surrounding the elbow
Treatment options
Mr Moverley will tailor your treatment specifically to the cause of your symptoms, whilst taking into account your expectations and medical history.
Non-operative Management
Non-operative treatment should always be exhausted before considering any form of surgery. In the majority of cases, tennis and golfers elbow are self-limiting conditions that resolve on their own over time. This time frame is variable and may last up to two years. Possible non-operative options include:
Rest, activity modification, and simple pain relief can provide good benefit, particularly early after the onset of symptoms.
The mainstay of treatment is physiotherapy, which will entail an eccentric loading exercise program. These are a specific type of elbow exercise that retrains and heals the affected tendons. Approximately 70% of individuals achieve a substantial, sustained improvement in symptoms following this treatment, which is why it is always recommended as the first line treatment.
Steroid injections have traditionally been used to provide short-term relief, which can then allow you to participate in physiotherapy. Repeated injections should not be given as a long-term solution as they may cause further damage to the tendon and may actually lengthen the duration of symptoms in the longer term.
Platelet rich plasma (PRP) injections are blood-based injections. These do not have the immediate pain killing properties of cortisone, but do contain a high concentration of the natural healing elements found in our blood. They act by kick-starting the repair process of the damaged tendon to provide a more long lasting solution to the problem. There is evidence that PRP injections are associated with improved results and as such they are approved for use by the National Institute of Clinical Excellence.
Surgical Management
Surgery is an option if despite a PRP injection and a structured physiotherapy program you are still experiencing pain that is causing you problems. Surgery may be performed open or arthroscopically (keyhole) and each has it’s advantages. Mr Moverley will discuss this in detail with you prior to any agreement to proceed to an operation.