The elbow joint links the upper arm bone (humerus) to the two forearm bones (radios and ulna). It enables us to bend, extend, rotate, and straighten the forearm (Dwyer, 2009). Whenever our arms need stability and support, our elbows allow precise and accurate movements. It is a pivotal joint for performing daily tasks like lifting, holding, and moving objects around us.
Your tendons connect your muscles to your bones. As you perform repetitive arm and wrist motions, this can result in overloaded elbow tendons. This leads to swelling, pain, and tenderness. This orthopaedic condition is called lateral epicondylitis or tennis elbow. In Singapore, treatment for tennis elbow pain includes surgical and nonsurgical methods, depending on your condition.
Tennis elbow, also known as lateral epicondylitis, is a condition that presents with pain over the outer part of the elbow joint. Despite its name, anyone can be diagnosed with tennis elbow. It is the most common cause of pain in the elbow region, as the pain frequently arises from muscle overuse from labour-intensive tasks.
A tendon, which looks like a thick cord, is a tissue that connects muscles to bones. When your forearm muscles are overused, it causes damage to the tendon (Alaia, 2020). Tennis elbow arises from degeneration from the extensor carpi radialis brevis (ECRB) tendon. This tendon is located in the outer portion of your forearm. The treatment of this condition is to promote healing of the injured tendon, by using whatever necessary combination of surgery, injections, medications, and physiotherapy.
(image source: https://www.news-medical.net/health/What-Causes-Tennis-Elbow.aspx)
Tennis elbow is typically caused by overuse of the forearm muscles over time. During manual labour such as cleaning or cooking, you may strain your muscles (Johns Hopkins Medicine, 2020). People can develop tennis elbow through:
If you often perform repetitive tasks that involve the forearms, wrists, or hands, you may be at risk for this condition. You may experience the following symptoms, which can worsen over time:
Tennis elbow symptoms can be similar to other health conditions. A consultation with your orthopaedic surgeon can help in properly diagnosing your specific ailment. The process may include:
(image source: https://www.gdosteopathy.co.uk/enfield/tennis-elbow/)
Surgical and Non-Surgical Treatment Options for Alleviating Tennis Elbow Pain
Tennis elbow pain can be attributed to many causes. Your orthopaedic surgeon will give you a treatment plan that will target the source of your pain (Johns Hopkins Medicine, 2020).
1.Surgical Treatments are usually the last resort for this condition, but it can be recommended for severe cases of tennis elbow.
2.Non-Surgical Treatments may also involve non-invasive or minimally invasive methods.
Tendon treatments have continued to develop throughout the years. Ultrasound guided tendon debridement is a new surgical procedure for early-stage tennis elbow cases. Debridement involves the removal of the damaged sections of tendons. The remaining healthy tendons are then sewn together (Masci et al., 2020).
(image source: https://www.csp.org.uk/conditions/elbow-pain)
Patients who underwent tennis elbow surgery may return to full activities 6 weeks to 2 months after the procedure. Most patients will regain full range of elbow motion within 2 weeks of surgery. Remember, treatment does not stop after the surgical procedure. You may be required to attend physiotherapy sessions as part of the recovery and rehabilitative plans (Cleveland Clinic, 2021).
Taking care of the elbow is important for joint health, continuous mobility, and injury prevention. It’s important to talk to an orthopaedic surgeon for effective diagnosis and treatment of elbow problems. They can give you personalised advice and treatment options for the best results and long-term health.
Despite the name, anyone can develop tennis elbow. People who engage in work, hobbies, and other activities that involve repetitive motions can develop this condition. This would include manual labourers who engage in forearm activities such as wringing, amateur and professional players of sports like tennis and golf.
In a majority of cases, corticosteroid injections can help alleviate tennis elbow pain. These are anti-inflammatory medicines that relieve pain and discomfort. As with any type of treatment, the degree of pain relief may vary from person to person.
Warming up before sports and other activities reduces the chance of injury. Taking breaks and stretching during work or exercise keeps muscles from getting tired and may improve your flexibility. These practises improve function, muscle recovery, and mobility.
Ultrasound-guided tendon debridement is an advanced treatment for early-stage tennis elbow. It involves surgically removing damaged tendon sections and suturing together the remaining healthy tendons. This procedure represents a significant development in tendon treatments, promoting effective healing and restoration.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, provide pain relief and reduce inflammation and swelling. These medications are effective in managing symptoms associated with pain and inflammatory conditions. NSAIDs can be beneficial for alleviating discomfort and improving overall comfort levels.
Physiotherapy for tennis elbow includes stretching exercises that enhance tendon recovery, improve flexibility, and promote healing. These exercises help reduce muscle tension and restore range of motion, facilitating a quicker return to normal activities.
After undergoing physiotherapy and receiving injections, patients with tennis elbow typically experience immediate and long-lasting pain relief. Within a month to six weeks, they can usually resume full activities with improved functionality and reduced discomfort.
Before using braces, splints, or other devices for orthopaedic problems, it is best to consult an orthopaedic surgeon. The usage of braces and splints would depend on the needs of the patients. There are other ways to treat tennis elbow pain including medications and physiotherapy.
Yes. To make sure your recovery is safe and successful, you should only do exercises recommended by a certified physiotherapist as part of an individualised treatment plan. When trying to deal with tennis elbow pain, it is important to be careful when doing any type of activity.
Ultrasound-guided tendon debridement is an advanced and recommended first-line treatment for severe tennis elbow pain. It involves the removal damaged tendon sections and promotes effective healing and restoration.
Corticosteroid injections have potential risks, including the main complication of fat atrophy, where the fatty tissue around the injection site may shrink. The worst complication associated with these injections is the risk of infection. Additionally, there is a small risk of tendon rupture associated with corticosteroid injections.
To make sure you get better after surgery for tennis elbow, you must do the exercises that the surgeon and trainer tell you to do. Also, it’s important to follow the suggested rehabilitation protocol because it’s a key part of healing and getting back to normal function.
Dr Yong Ren graduated from the National University of Singapore’s Medical faculty and embarked on his orthopaedic career soon after. Upon completion of his training locally, he served briefly as an orthopaedic trauma surgeon in Khoo Teck Puat hospital before embarking on sub-specialty training in Switzerland at the famed Inselspital in Bern.
He underwent sub-specialty training in pelvic and spinal surgery, and upon his return to Singapore served as head of the orthopaedic trauma team till 2019. He continues to serve as Visiting Consultant to Khoo Teck Puat Hospital.
Well versed in a variety of orthopaedic surgeries, he also served as a member of the country council for the local branch of the Arbeitsgemeinschaft für Osteosynthesefragen (Trauma) in Singapore. He was also involved in the training of many of the young doctors in Singapore and was appointed as an Assistant Professor by the Yong Loo Lin School of Medicine. Prior to his entry into the private sector, he also served as core faculty for orthopaedic resident training by the National Healthcare Group.
Dr Yong Ren brings to the table his years of experience as a teacher and trainer in orthopaedic surgery. With his expertise in minimally invasive fracture surgery, pelvic reconstructive surgery, hip and knee surgery as well as spinal surgery, he is uniquely equipped with the tools and expertise necessary to help you on your road to recovery.
Alaia, M. (2020). Tennis Elbow (Lateral Epicondylitis). Retrieved
https://orthoinfo.aaos.org/en/diseases–conditions/tennis-elbow-lateral-epicondylitis/
Cleveland Clinic. (2021). Tennis Elbow (Lateral Epicondylitis). Retrieved from
https://my.clevelandclinic.org/health/diseases/7049-tennis-elbow-lateral-epicondylitis
Dwyer, T. (2009). The Bone School. Retrieved from http://www.boneschool.com/
Johns Hopkins Medicine. (2020). Lateral Epicondylitis (Tennis Elbow). Retrieved from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/lateral-epicondylitis-tennis-elbow
Masci, L., Alfredson, H., Neal, B., & Wynter Bee, W. (2020). Ultrasound-guided tendon
debridement improves pain, function and structure in persistent patellar tendinopathy: short term follow-up of a case series. BMJ open sport & exercise medicine, 6(1), e000803.
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