News

05-01-2015

The XXVII Hopman Cup tennis tournament has begun at the Perth Arena and watching the tennis may inspire some to pick up a racket and play , but often without the training and technique of the regular tennis players, leading to elbow pain and what is known as Tennis Elbow.

Tennis Elbow ( lateral epicondylosis) is the most common cause of elbow pain , most cases do not occur in those playing tennis ( it is said to affect between 1-3% of the general population at some time). The condition affects the tendons on the outside of the elbow and interferes with activities that involve gripping and moving objects with your hands.  It can last between 3-6 months. The condition most often comes on slowly without a definite activity or initiating event.

It is associated with overuse or repetitive strain rather than an acute inflammatory reaction, hence the change of name from epicondylitis. Collagen fibres that make up a tendon breakdown in a complex fashion that involves a complicated overgrowth of tissue as a result.

 

Risk factors are said to be smoking, obesity, age 45-55yrs, repetitive movement for at least 2 hrs per day and isolated forceful activity such as lifting ( particularly loads over 20kg), or suddenly playing a prolonged game of tennis.

 

Diagnosis is relatively straightforward , treatment choices are controversial with many options being available, but limited scientific evidence supports any one protocol.

70-80% of cases will settle with minimal intervention over 3 months.

 

Most treatments plans do involve modifying the activity and biomechanics that are thought to be the triggers , in tennis, no one has researched in a evidence based  way as to how to judge correct grip, racket style and weight , but if you develop a pain, modifying the tool and activity whether racket or computer use may help ( many guidelines exist, but none are yet evidence-based)

 

Treatment options usually involve:

  • Rest from the painful activity, but not in a sling
  • Ice ( 15 minutes 3-4 times daily)
  • Message
  • Acupuncture
  • Exercises to strengthen and rehabilitate the tendon are usually considered useful, but also lack scientific evidence despite being the mainstay of most management plans. The idea is to realign the collagen fibres and improve their tensile strength.
  • Bracing the elbow to rest the painful tendon when performing tasks that increase pain for a short time
  • Anti inflammatory treatments : gels and anti inflammatory medication have little evidence of benefit
  • Steroid injections have been shown to achieve 80% successful reducing the pain in the first 3-4 weeks, but there has been shown to be up to 60% recurrence and have never been shown to be of longer term benefit ( tendon rupture as a side effect is a rare but serious complication given as 1:1000 injections)
  • Iontophoresis has no evidence of benefit scientifically Others treatment that are used, but remain of uncertain benefit include:
  • Platelet rich plasma injection, autologous blood injection, extra corporeal shock wave therapy, acupuncture, botulinum injection, prolotherapy, topical glyceryl Trinitrate application, autologous tenocyte injection and sclerosing poidolanol injections

 

Most people suffering from tennis elbow respond to a combination of non- operative treatments, those not responding may benefit from surgical interventions, but again there are no published controlled trials yet available. It is advised to consult a surgeon with experience in the area when the problem has not settled ( said to be after 3 months conservative management)

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