What is a Tennis Elbow?

Lateral epicondylitis, or tennis elbow, is a painful condition that occurs when a tendon located at the outer part of the elbow is inflamed. The pain is found on the outer side (lateral side) of the elbow, and may extend down to your wrist or fingertips. Pain is usually felt when you straighten your elbow, or fully extend your arm.

Pain associated with tennis elbow may also extend from the elbow towards the wrist. You might also find yourself unable to grip objects properly, and have pain when performing day to day activities such as lifting loads, and grasping objects.

How does the tennis elbow occur?

The tendon involved is the extensor carpi radialis brevis (ECRB) tendon, which arises from the outer portion of the elbow. The muscle helps to extend the wrist, and is one of the stabilisers of the wrist especially when the elbow is held straight.

Despite the name tennis elbow, this injury is more commonly due to overuse, during activities that require repetitive wrist extension movements, such as in wringing of wet clothes, painting, or carpentry. The location of the tendon close to bony prominences on the outer portion of the elbow also further predisposes it to damage. Small tears in the tendon arise as a result, which causes pain and inflammation.

How is tennis elbow diagnosed?

Your doctor will begin by conducting a medical interview, asking in particular about questions pertaining to the duration of symptoms, and about activities which may have resulted in your injury.

Based on the information gleaned, he/she will conduct a focused examination on the elbow, which may include palpation of the tendon involved. Provocative tests may also be performed in order to elicit pain similar to that experienced during activities.

Clinical examination and history taking are frequently all that is required to diagnose tennis elbow. In cases where there is any doubt, an ultrasound or MRI scan may be offered to confirm the diagnosis.

How is outer elbow pain treated?

Non-surgical

Non-surgical treatment is the mainstay of treatment for most patients. This can entail a combination of several therapies including,

1. Rest and avoidance of activities may be prescribed by your doctor in order to allow time for the tendon to recover.

2. Anti-inflammatory pain medication, which helps to reduce swelling and pain at the site of the tennis elbow.
3. Physical therapy, where stretching exercises and other modalities are used to aid recovery of the inflamed tendon.
4. Injection therapy, where medication or healing factors are injected at the site of the tendon injury to promote healing of the tendon.
5. Steroid and local anaesthetic injections are safe, have anti-inflammatory effects, and give good pain relief in majority of patients.4.For patients with recalcitrant tendon pain, platelet enriched plasma, where healing factors derived from your own blood are injected to help heal the tendon, can also be considered.
6. Shockwave therapy is another good option, where shockwaves generated by a machine are used to stimulate healing in damaged elbow tendons.

Surgical

Surgery is only necessary, if non-surgical methods have been attempted, but fail to resolve the elbow pain. If deemed necessary, radiofrequency ablation (RFA) of the ECRB tendon can be considered.

RFA is a minimally-invasive procedure that helps to promote angiogenesis – the development of new blood vessels. RFA is also used to stimulate healing of the ECRB tendon, effectively treating tendon damage and subsequently, outer elbow pain.

For an assessment of your condition, please book an appointment with Dr. Yong Ren.

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