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Tennis Elbow

Lateral Epicondylitis

What is it?
Despite the name it can occur in non tennis players and individuals involved in lifting or repetitive movements

What are the signs and symptoms?
Pain is felt over the outside of the elbow joint, especially on lifting with the palm facing the ground. A small area (the lateral epicondyle) is usually exquisitely tender. Pain may spread down into the forearm. Gripping and carrying makes the pain worse.

How is the diagnosis made?
The specialist will listen to the description of events and examine the elbow. X-rays will also be taken to exclude any other disorders. In difficult cases an MRI may be required.

What is the initial treatment?
It is important to determine the cause of the condition so that recurrence may be avoided. If it is sports related, the equipment or grip must be altered. Often the racquet handle is too small or too big for the hand. Avoidance of the painful activity can help symptoms settle.

Anti-inflammatory drugs can be used to help reduce inflammation and help with pain.

Physiotherapy and a forearm strap can be used to take the tension of the tendon / bone interface. This offloads the insertion of the extensor forearm muscles from the lateral epicondyle

If simple measures do not work then further treatment can be considered

An injection of local anaesthetic and steroid into the most tender spot (the lateral epicondyle) gives instant relief and allows therapy to begin. Exercises to improve wrist flexibility and increase the wrist flexor and extensor muscle strength must then be started, as these are part of the initial problem. A further 1-2 injections may be given if the symptoms recur. This usually resolves symptoms in the large majority of cases

If initial treatment doesn't work, what's next?
If injections and therapy fail to settle the symptoms then surgery may be required to excise the scar tissue over the lateral epicondyle.  

Mr Sameer Singh's specialist areas