What is this?
Tennis elbow (lateral epicondylitis) is the most common painful condition of the elbow. Pain occurs on the outside of the elbow at the bony prominence known as the epicondyle, where the muscle/tendons of the forearm and wrist attach. Golfer’s elbow (medial epicondylitis) is a similar less common condition that causes pain on the inner side of the elbow. Despite the names, the conditions are rarely caused by golf or tennis. The pain is caused by repetitive damage and degenerative changes within the muscles/tendons of the forearm and wrist at their attachment site onto the bone.
What are the symptoms?
The pain and tenderness around the outside (tennis elbow) or inside (golfers elbow) of the elbow is aggravated by activities that involve gripping and movements of the wrist. The pain can also be referred further down the forearm.
Will I need any further investigations?
Tennis and golfer’s elbow are usually diagnosed on history and examination findings. An x-ray may be required to exclude other causes of a painful elbow. More specialist tests such as ultrasound or MRI scans are occasionally needed if the diagnosis is not clear.
What are the non-surgical treatment options?
Simple splinting and physiotherapy may relieve the discomfort in early and mild cases. More resistant cases may respond to a steroid injection into the affected area or needling to encourage bleeding from the bone and start the healing process. One of the latest treatment options developed for the treatment of tennis elbow is the injection of platelet-rich plasma (PRP): instead of steroids, the patient’s own platelets (blood-clotting cells) and growth factors are taken from their own blood, concentrated in a centrifuge and injected into the diseased tendon. A small proportion of patients will not respond to the above treatments and may require surgery.
What does surgery involve?
Surgical treatment for both tennis elbow and golfer’s elbow is performed via a small incision. Both involve release of the affected muscle/tendon insertions from the bone and removal of the abnormal tissue. The bone surface is then roughened (decorticated) to allow bleeding and help the scarring/healing process.
What is the success of surgery?
Generally, this is a safe and reliable operation to relieve your symptoms. The success rate with surgical treatment is around 80-90% although it may take several months to feel the full benefit from the surgery.
What are the potential risks of surgery?
Any surgical procedure carries risks, however every effort is made to minimise these to ensure the best possible outcome from your surgery. The commonest risks of surgery include infection, bleeding, scar tenderness and failure to fully cure the problem.
What is the recovery after surgery?
After 2-3 days the bandage around the elbow can be removed and you can begin gently moving the elbow with light activity. Excessive elbow movement should be avoided for the first 2 weeks as the wound is healing. There will be an adhesive dressing over the wound, which can usually be left undisturbed until your follow-up appointment at around 2 weeks. You will be seen in clinic two weeks after surgery to check the wound and assess recovery. There are no sutures to be removed as they are will dissolve under the skin.
When can I return to normal activities?
Return to work depends on the nature of the job. You can return to desk and computer work when you feel comfortable to do so but avoid any manual work, heavy lifting or sporting activities for 4-6 weeks. It may still take 3-6 months to fully recover. You may return to driving when you feel safe to control the vehicle, which is usually about 10-14 days after surgery.