Everything You Need to Know About Tennis Elbow

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Tennis elbow is a condition where you have pain on the outer side of the elbow. It is often caused by overuse strain, causing damage of tendons around your elbow. In many people, symptoms improve over time just by stopping activities that bring on the symptoms.

How does tennis elbow present?

For most people with tennis elbow, the pain only occurs when they use their forearm and wrist, particularly for twisting movements such as turning a door handle or opening a jar. However, for some people the pain is constant; it occurs at rest and can affect their sleep. The pain may travel down your arm from your elbow towards your wrist. You may find it difficult to hold items such as a knife or fork, a cup or a pen, or to straighten your arm fully

What causes tennis elbow?

The site of the pain in tennis elbow is where some tendons from your forearm muscles attach to the bone around your elbow. The pain is thought to be caused by swelling or thickening of the tendon, and eventually degeneration.

This damage is usually caused by overuse of your forearm muscles in repeated actions.

Who gets tennis elbow?

About 1 to 3 people in 100 have tennis elbow. It mainly affects people between the ages of 40 and 50. Women and men are affected equally.

Tennis elbow is more likely to occur if you have unfit forearm muscles. For example, if you suddenly play a lot of tennis whilst on holiday or you do some gardening when you are not used to strong forearm actions. However, even if you are used to heavy work, you can overdo it and injure a tendon. People whose work involves repeated twisting and gripping actions, such as carpenters and plasterers, are prone to getting tennis elbow.

In some people, the condition develops for no apparent reason without any prior overuse or injury to their arm.

How is tennis elbow diagnosed?

Your doctor can usually diagnose tennis elbow by talking to you about your symptoms and by examining your arms. You will typically experience pain when the doctor examines the outer part of your elbow. Your doctor may also ask you to move your wrist in a particular way, as this will usually bring on your pain.

Tests are not usually needed to diagnose tennis elbow. However, if after some time your tennis elbow is not improving, your doctor may suggest that they refer you to a specialist.

What are the treatment options for tennis elbow?

Pain relief

Ice can sometimes be a good pain relief if you have tennis elbow

Painkillers such as paracetamol, with or without codeine added, may be helpful.

Also, anti-inflammatory painkillers such as ibuprofen are commonly used to ease pain in tennis elbow. Some anti-inflammatory painkillers also come as creams or gels which you can rub over your painful elbow.

Physiotherapy

Physiotherapy has been shown to be helpful in the treatment of tennis elbow. Studies have shown that physiotherapy may not be as good as a steroid injection at relieving pain in the short term (that is, within the first six weeks). But, it may be superior to steroid injections in the long term.

Supports and splints

These can include wearing a special elbow armband or bandage. This may help to give support and protection to your elbow until symptoms ease.

Steroid injection

If the above measures do not work, or if you have severe pain and difficulty using your arm, an injection of a steroid into the painful area of your elbow may ease the pain.

A number of studies have shown that steroid injections may be helpful in easing pain in the short term but that pain tends to come back in many people. Build up your activities over some weeks to try to reduce the chance of your tennis elbow coming back.

A steroid injection may sometimes be repeated after some weeks if pain recurs. However, it is usual to have no more than three injections at the same site.

Autologous blood injection

Blood is taken from you and then injected into the area around the damaged tendons at your elbow. It is thought that the blood helps to heal the tendons. A local anaesthetic is often given as a pain relief during the procedure. Several treatment sessions may be needed. You may need to wear a splint after the procedure and will often be offered physiotherapy.

Surgery

If your tennis elbow symptoms persist for some time and are really troublesome then a specialist may advise an operation. The common operation to ease symptoms is to remove the damaged part of the tendon. Only a small number of people require surgery to relieve symptoms.

What is the outlook for tennis elbow?

If you rest your arm and avoid any activities that bring on your symptoms, your tennis elbow will usually settle over time. Rest and painkillers are all that most people with tennis elbow need.

For most people, tennis elbow lasts between six months and two years. Most people are better in less than one year. Unfortunately, once you have had tennis elbow, it may return. For a few people, tennis elbow does not improve on its own and needs more drastic treatment such as surgery.

Written by Dr Valentina Kirova-Veljanovska

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