What is tennis elbow?
Tennis elbow (lateral epicondylitis) is typified by pain on the outside of the elbow. The pain is caused by inflammation of the tendons that extend the wrist. It starts with repetitive overloading, which causes small tears in the tendon. When these don’t heal fully, the quality of the tendon reduces and the pain is exacerbated.
Before you come and see a surgeon
If your GP believes you have Tennis elbow, they may arrange an ultrasound scan and an x-ray to confirm the diagnosis prior to referring you for physiotherapy. If required, we recommend ONLY ONE injection of steroid under ultrasound guidance. There is now evidence that multiple injections can cause long-term skin changes and may prevent full recovery even after surgery. In the vast majority of cases, things will settle down by around 6 months to one-year.
Your surgeon will examine your elbow and may perform some tests that cause pain; these are important to confirm the diagnosis. Usually, we will check that you’ve had an x-ray and an ultrasound to confirm the diagnosis but these are not always necessary. In cases of previous failed tennis elbow surgery we will normally arrange an MRI scan.
What is the treatment?
Tennis elbow responds well to the correct physiotherapy regime. In addition, a course of anti-inflammatory medications and a tennis elbow clasp may help. If you have not previously had one, an injection of steroid may be considered. If you fail to respond to the above measures, we may discuss surgery with you.
Tennis elbow release surgery can be done through open or keyhole surgery. In both cases, inflammation and scar tissue is removed from the attachment of the tendon. The benefit of keyhole (arthroscopic) surgery is that the whole joint can be inspected and additional pathology treated at the same time.
After the surgery
The elbow is protected in a bulky bandage that can be removed after one week. The wound should be kept dry, clean and covered until 2 weeks postoperatively. The elbow can be moved gently from Day 1 postop but you should try and avoid activities that cause pain. You can return to normal activities from 6 weeks as pain allows.
Surgery is successful in around 90% of cases, but the duration of time it takes to improve is very variable (generally 3-6 months for full resolution). In some cases there remains some mild pain during exercise and very rarely there is no improvement following surgery.
Mr Sam Vollans
Consultant Orthopaedic Surgeon
I graduated from the University of Leeds and completed my specialist training in Yorkshire. Following this, I undertook further training in both elective and trauma shoulder & elbow surgery in Sheffield with David Stanley, David Potter and Amjid Ali.
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