Tennis / golfer's elbow

Tennis elbow describes pain from the extensor muscles attached to the outside of the elbow (lateral epicondylitis). Golfer’s elbow is a similar condition arising from the flexor muscles attached to the inside of the elbow (medial epicondylitis). These muscles help stabilise the wrist and are loaded when you grip. They can become weakened from overuse, resulting in microscopic tears in the tendons where the muscles attach to the elbow.

This can cause inflammation and pain. The tendons may also rub against bony bumps in the elbow as it bends and straightens, causing wear and tear.

These conditions can affect anyone who makes repetitive arm movements or lifts heavy weights, such as sports people and people involved in manual work. Sometimes it occurs for no apparent reason. The condition is most common in people aged between 30 and 50.

Symptoms include:

• Pain or burning on the outer or inner part of the elbow.
• Loss of strength when gripping due to pain.

Tennis and golfer’s elbow are normally diagnosed using a physical examination to check for the site of pain and certain movements that cause pain. You will normally be asked about your occupation and participation in sports, as well as how and when the symptoms first developed.

Tests may be recommended to rule out other causes of pain and to confirm the diagnosis. These might include:

• X-rays to rule out arthritis.
• MRI scan to look for injury or tear in the tendons, or problems in the elbow joint itself causing similar pain.

In most cases, tennis/golfer’s elbow can be treated without surgery. In the first instance you should avoid using the affected arm for sports or heavy activities that are making the pain worse. Most people find that the severe pain settles within a few weeks after rest. Beyond that you may experience some grumbling pain, aggravated by certain activities, that continues for up to a year, but is mangeable.

Painkillers and anti-inflammatories can help to control the pain and you may need to wear a strap on the forearm to protect the muscles and tendons.

A physiotherapist may be able to recommend exercises to strengthen the muscles of the forearm. Injections of corticosteroids into the affected area can help to relieve pain and reduce inflammation although in some cases the condition can return and be more painful after injections.

If the pain started with a clear injury and isn’t settling within a few weeks, then this should be investigated, sometimes including an MRI scan, to ensure the tendons are not torn.

In cases without clear injury where the severe pain isn’t settling, it is affecting everyday life significantly or keeps coming back, you may require special injections or surgery.

Special injections include PRP (platelet rich plasma) which is where a sample of your own blood is spun to extract the healing factors and stem cells. This is then reinjected into the painful tendon to promote healing.

Surgery can be very effective in some cases and is designed to remove damaged or abnormal tissue and reattach healthy tendons to the bone. This may be performed arthroscopically (by keyhole surgery), or using conventional open surgery. After surgery you will need to rest from heavy use for a few weeks and perform exercises recommended by a physiotherapist to help you to heal and rehabilitate fully. Pain should start to improve by around 6 weeks, although it can take months for the tendons to fully rehabilitate.