Dr. Kaiwan M. Randeria is an Orthopedic Surgeon, holding a Fellowship in Joint Replacement Surgery. He aims to increase awareness about bone health, which has been adversely affected in keeping with today’s unhealthy lifestyle and nutritional issues. [Connect with him at: drkaiwan94@gmail.com ]

As an Orthopaedic surgeon, I encounter numerous patients with musculoskeletal issues, and one of the most common yet misunderstood conditions is lateral epicondylitis, more commonly known as ‘tennis elbow’. Tennis elbow is a form of tendinopathy (condition wherein tendons are inflamed), specifically affecting the tendons that attach to the outer part of the elbow. Contrary to the name, this injury is not exclusive to tennis players, racquet sports or athletes. It occurs when these tendons, which are responsible for extending the wrist and fingers, become inflamed or degenerated due to overuse or repetitive strain. It can affect anyone who engages in repetitive arm motions, especially those involving gripping or lifting and wrist movement.

Symptoms of Tennis Elbow

Patients with tennis elbow typically experience symptoms including pain or tenderness on the outer side of the elbow, which may radiate down along the outer forearm; Pain with gripping activities such as shaking hands, holding a cup, or lifting objects; Weakness in the forearm muscles, which can affect daily tasks like turning a doorknob or lifting groceries; and Pain with repetitive wrist extension or activities that require holding objects at arm’s length.

Diagnosis

The diagnosis of tennis elbow is primarily clinical. A thorough history and physical examination are essential. Patients typically describe pain or discomfort on the lateral side of the elbow, often exacerbated by gripping or wrist extension activities. One should not try and self-diagnose this condition as there can be some other conditions too which mimic similar symptoms. For some cases, imaging studies like Sonography, X-rays or MRI may be used to rule out other causes of elbow pain, such as fractures or arthritis and confirm a diagnosis by detecting the tendinopathy.

Treatment Options

Treatment for tennis elbow is generally non operative and aimed at relieving pain, reducing inflammation, and promoting healing. Most patients recover with non-surgical interventions, though the timeline can vary.

Rest and Activity Modification: The first step in treatment is to rest the affected elbow. Patients should avoid activities that exacerbate symptoms, particularly repetitive wrist movements, until the pain subsides.

Ice Therapy: Applying ice packs to the affected area for 15-20 minutes several times a day can help reduce inflammation and pain.

Non-Steroidal Anti-Inflammatory Drugs (Painkillers): NSAIDs can help reduce pain and inflammation in the early phase. However, these should be taken after ruling out allergies and must be consumed judiciously and not as a long-term solution due to potential side effects.

Physical Therapy: A key component of treatment is physical therapy in conjunction with your orthopaedician. Stretching and strengthening exercises, particularly those targeting the forearm and wrist muscles, can help restore function and reduce strain on the tendon. Sometimes, ultrasound therapy may also help reduce inflammation.

Bracing or Splints: Using a forearm strap or elbow brace can help reduce stress on the tendons by redistributing forces away from the affected area. These devices are particularly useful during activity.

Corticosteroid Injections: For patients with persistent pain who do not respond to conservative treatments, corticosteroid injections can provide temporary relief. However, repeated use of steroids should be avoided due to potential tendon degeneration.

Platelet-Rich Plasma (PRP) Therapy: In recent years, PRP injections have gained popularity for treating tendinopathies, including tennis elbow. By using the patient’s own blood to promote healing, PRP can reduce inflammation and stimulate tissue repair.

Surgical Treatment

While most cases of tennis elbow resolve with conservative treatment, about 5-10% of patients experience chronic symptoms that don’t improve. For these individuals, surgical intervention may be considered as a last resort. Surgery is usually reserved for cases that persist for very long despite conservative measures and involves release of the tight tendons

Prevention

Preventing tennis elbow involves addressing risk factors and modifying behaviour. Some strategies include:

Proper Technique: Ensuring proper biomechanics during activities like tennis or lifting can reduce strain on the elbow. For example, using the correct grip size on a tennis racquet or using well designed tools during manual labour can be helpful.

Strengthening Exercises: Regularly strengthening the forearm muscles can increase their capacity to handle repetitive tasks and reduce the risk of injury.

Ergonomics: Adjusting workplace ergonomics, such as using a keyboard and mouse at the proper height and angle, can reduce the risk of developing tennis elbow, particularly in office workers.

Regular Stretching: Stretching the forearm muscles before engaging in physical activity or repetitive tasks can help maintain flexibility and reduce strain on the tendons.

Tennis elbow is a common yet treatable condition, particularly if caught early and managed appropriately. Conservative treatments like rest, physical therapy, and anti-inflammatory medications are often effective, and most patients can return to their normal activities without the need for surgery. For those who do not improve with conservative treatment, surgical options remain a viable last resort.

[Disclaimer: The contents of this article should not be considered as formal medical advice. Kindly visit your orthopaedician for any related treatment.]