Tennis and Golfers’ Elbow (also called lateral and medial epicondylitis)
What is it?
The outer and inner bony prominences (lateral and medial epicondyles) of your elbows are the tendinous points of origin for your forearm muscles. Repetitive microtrauma, or just ageing with increased use, can cause these tendon origins to become degenerate and painful.
The particular tendon origin at fault in tennis elbow is almost always the Extensor Carpi (wrist) radialis brevis (ECRB). This tendon originates just outside the capsule of your elbow from right on the tip of your outer elbow prominence (lateral epicondyle). Its function is to extend (bend back) your wrist and its far end inserts into the base of your middle finger’s metacarpal bone. Grip becomes painful in tennis elbow as you need to extend your wrist in order to grip firmly.
Elbow tendinopathy is very common, affecting 3% of us: typically people aged 35-55 years. Some patients will put their onset down to an intense period of activity or sport, but others will recall no cause.
What is Golfers’ Elbow?
Golfers’ elbow is caused by the same form of tendon degeneration as in tennis elbow, but golfers’ affects the inner, rather than outer prominence of your elbow. This is where the flexor muscles of your forearm, wrist and hand originate. It is about four times less common than tennis elbow.
Some patients will also experience symptoms of an irritable ulna nerve, which lies just behind the medial prominence of your elbow (symptoms include: pins and needles in the little finger, shooting pains when tapped over inner elbow, pain and weakness in the forearm and hand).
The principles of treatment are the same as for tennis elbow: activity and technique modification, physiotherapy, PRP injection and surgery as a last resort
Most patients describe a gradual onset of pain felt over the outer prominence of their elbow (lateral epicondyle). Pain typically comes on when gripping objects, or performing certain forearm movements. As the condition becomes more chronic, the pain may deteriorate into a constant ache and most movements of the arm may exacerbate pain.
Occasionally other conditions can mimic tennis elbow. Your surgeon will take a careful history and examine you to pinpoint your diagnosis. In some cases you may be asked to have an ultrasound or MRI scan, or even a nerve test, to help confirm your diagnosis. Conditions that also cause pain over the outer aspect of your elbow include:
Thankfully the natural history of tennis elbow is that it tends to resolve. Approximately 80% will achieve resolution of their pain by one year. However, for some the problem will persist and your GP may refer you to a specialist.
The first thing to do is to identify whether a specific activity is causing your problem (e.g. tennis, weight training or a change in work role). If this is the case, then modifying your technique, grip size, frequency of play or your work environment and duties can help achieve resolution.
The next step is to undergo physical therapy. Physiotherapists will teach you stretches and a specific form of strength training (eccentric training) for your muscles. There is good evidence that this exercise regime is successful at improving symptoms in the majority of patients (50-85%). Of course, it is vital that you diligently perform these exercises to maximise your chance of success. The physiotherapy programme will take three to achieve its effect.
Other modalities sometimes employed by therapists, such as ultrasound, laser and shock wave have been tried in tennis elbow, but they are either only transiently effective, or useless. They are therefore not recommended.
Some patients will derive benefit from wearing a brace, although the evidence for their use is less clear than for physiotherapy. This may involve either a strap placed over the upper forearm, or a wrist splint. A comparative study showed the wrist splint to be superior. If you use a splint, it is important that you still undertake the eccentric physiotherapy programme.
Platelet Rich Plasma or Autologous Blood Injections
Our blood contains cells called platelets. These cells secrete growth factors that stimulate tissue repair.
Autologous blood injection aims to promote tissue healing and relieve your pain. Autologous blood involves the injection of 1.5-3ml of your own blood into your affected tendon.
Platelet rich plasma (PRP) is more sophisticated and aims to provide a higher concentration of the platelets that can promote healing. For PRP, 15ml of your blood is taken and spun in a centrifuge to separate the platelet rich layer. This material is then injected. Both ABI and PRP are effective in improving patient symptoms by three months, but PRP is marginally superior in comparative studies.
It is important that you avoid non-steroidal anti-inflammatory drugs (NSAIDS), such as: aspirin, naproxen, ibuprofen and diclofenac for at least a week before, and for the first three weeks after treatment, as these drugs stop the platelet cells from working.
A recent study into the use of PRP in a population of patients with troubling chronic elbow tendinopathy showed that 70% responded well enough to avoid the need for surgery.
Most patients improve without surgery, either through natural healing with time, or with the help of physiotherapy +/- PRP injection. The minority who undergo surgery tend to do so only after these less-invasive strategies have failed. Before committing to surgery it is important that your diagnosis is confirmed, as other problems can sometimes mimic tennis elbow. Your surgeon may therefore order investigations such as ultrasound or MRI scans to confirm the diagnosis.
Surgery for tennis elbow can be performed either by open or keyhole surgery. See Procedures - Elbow - Tennis Elbow Release
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
BMI The Princess Margaret Hospital
Osborne Rd, Windsor SL4 3SJ
Spire Thames Valley hospital
Wexham Street, Wexham, Buckinghamshire, SL3 6NH
BMI Bishops Wood Hospital
Rickmansworth Road, Northwood, HA62JW
Wexham Park Hospital, Slough, Berkshire, SL2 4HL