Tennis & Golfer’s Elbow

Treatment for Tennis Elbow

Everything I am going to say about Tennis Elbow also holds good for Golfers Elbow so, to make things easier, I am just going to use Tennis Elbow in this section but remember we are discussing both conditions. Golfers Elbow is pain and tenderness on the inside of the elbow and Tennis Elbow is on the outside.

And the other thing to add straight away is that you don’t have to play Tennis to get Tennis Elbow or Golf to get Golfers Elbow!

We have to learn a little bit of anatomy to understand what happens to give you Tennis Elbow. A tendon is the bit of tissue that joins a muscle to a bone and the easiest one to visualise is the calf muscle which is connected to the heel bone by the Achilles Tendon. In the forearm the tendons start at the finger tips and then link into the big groups of muscle on the forearm before becoming a tendon again that joins to the sticky-out bit of bone on the outside (Tennis) or inside (Golfers) of the elbow. The proper name for those bony protruberances is an epicondyle and the technical name for Tennis Elbow is Lateral Epicondylitis. In laymans terms that means inflammation of the tendon at the elbow.

It can be quite easy to irritate, annoy and inflame the tendon with overuse or, somteimes, an acute injury which causes the pain. And if the irritation continues then the inflammation can change into degeneration. That happens because tendon doesn’t have a very good blood supply at the best of times and if there is very little blood flowing through it then it doesn’t get much oxygen or many nutrients from the blood. And when you make a fist and tense up the forearm muscles, what little blood there was going to the tendon decreases even further. So no blood means no oxygen and no nutrients and if a tissue is starved of those things then it can actually start to die. That sounds rather dramatic and the technical term we use is degeneration but it amounts to the same thing.

So doing activities where you have to make a strong grip for longish periods causes Tennis Elbow.

There can a lot of inflammation there initially as well which is why anti-inflammatory tablets or creams can help and why steroid injections may help because they reduce the inflammation bit of the condition. But they don’t help with the longer term degeneration and thats when we have to consider other treatments.

So how do I know if I’ve got Tennis Elbow?

The usual problems are pain in the forearm and the point of the elbow when you are making a grip. That can mean something as simple as picking up a bottle of milk or holding a pen but frequently it is involved with sports. Obviously Tennis and Golf but also using weights in the gym, holding a badminton or squash racquet or a cricket bat. It can effect people who have jobs that involve gripping and lifting such as painters and decoraters, plasterers and brick layers. But it doesn’t have to be as physical as that. It can be a big enough problem just trying to live your life day to day.

How do I make it better? What is the treatment?

There are lots of different ways to treat Tennis Elbow and when there are lots of different options available that usually means that none of them works for everybody. Some people can do brilliantly with a steroid injection whereas at the other end of the spectrum some people will need an operation to get them better.

Can’t I just leave it alone? Won’t it get better eventually?

Of course you can. If you can manage with the pain and it isn’t stopping you working or enjoying your sports then by all means wait it out. A Tennis Elbow strap might be worth trying just to make life a bit easier. If you ask Doctors and Surgeons how they have dealt with their own Tennis Elbow, you will find that very, very few have any interventional treatment: most just manage it and wait till it gets better!

It’s too painful and I don’t want to wait. What do you suggest then?

I think a steroid injection is a very good place to start and in fact I recently had one for my Tennis Elbow when it became so bad that and I couldn’t work or do my sports.. Steroid injections can be very helpful especially in the early stages when the main problem is inflammation rather than degeneration and I will usually advice a steroid injection if you haven’t had the pain for too long (less than 6 months) and if there is a clear painful spot to inject.

The injection is done under ultra-sound control by a radiologist and it is a very different beast from the traditional blind stab that I used to do. In fact the injection goes around the tendon rather than straight into it.

My exoperience of it was minimal pain and a much better elbow after about 10 days. It’s not perfect but it is now entirely manageable and I can do all I want with my arm and hand.

Do you do the injection and how many will I need?

If you have already had one from your GP and then the pain has recurred I will actually organise an Ultra-sound scan and you will have your injection done by the Radiology Consultant doing the scan at the same time. If you developed the symptoms after a fall or bashing the elbow then I will probably do an MRI scan and revew you with the results of that before deciding what to do.

Sometimes you might need a second and occasionally a third injection.

You said there were lots of other treatments. What about them?

You are right. There are quite a few other treatments that are advocated by other specialists and I have tried some of them myself over the years. But the honest truth is that there is no strong evidence that any of them really work. And as a Consultant I should only be using treatments that have been shown to work not just ones I think might work.

So, I have now stopped using Extra-Corporeal Shock-wave Treatment (ESWT) and GTN patch therapy. The theory behind these treatments seemed quite sensible but, although they have helped with some of my patients, they haven’t really helped with a big enough percentage to warrant going om using them.

Another ‘trendy’ therapy is injecting PRP. Again this appeared to be a reasonable option but there has been on scientifc evidence that it makes any difference so there is no place for that either!

What about physiotherapy? Does that help?

I believe that it does and you should have a couple of sessions with the physiotherapist who will show you some stretches to do to help reduce the pain and prevent any recurrence.

Do I have to stop doing everything that hurts while it gets better?

Some things you should stop for the first 6 weeks; sports which were definitely causing you pain, for example. But if it is your job or something equally important then you can’t really stop. What I suggest is that you ‘manage’ your symptoms so you can do some things (if you can cope) and avopid others (if you can’t). You won’t really be making it any worse and no-one knows if using the elbow makes the condition last any longer.

Will a Tennis Elbow strap help?

I do think a Tennis Elbow Strap does help reduce pain when you have to use the elbow. The strap works by diverting the force created when you make a fist so that it stops at the level of the strap and doesn’t go through to the point of the elbow.  Getting the right strap and putting it on properly is essential so watch the video to see how to do it.

What about stopping it coming back?

That’s a very good point and I think it is important to look at that. It can be well worth while looking at the size of the grips on your racquets, clubs or bats.  Making them a bit bigger means you shouldn’t need to make such a tight grip. It is also worth looking at your technique and the way you make a grip to see if you can loosen that up a bit. In the gym try doing ‘open palm’ exercises. This means using weights machines rather than free weights and pushing and pulling using the palm of the hand rather than making a grip. You can’t do it for all exercises but you can for a lot and again it takes the pressure off the tendon.

How long does it take to get better?

That is the million dollar question – anything from a few months to several years. Hopefully the steroid injection will do the trick early on but it is ore likely to be an on-going issue to some level or another for a year.

And if it doesn’t settle?

If we really get nowhere with all this and the pain is bad enough or has come back again then we can consider an operation. And, like everything with Tennis Elbow, it can be great and within 6 weeks you could be back to normal. You can find out about the surgery in the ‘operations’ section.

 

Tennis and Golfers Elbow are difficult conditions to treat. There are a vast range of options all of which might work for some people but none of which works for everybody. I believe that we should only be using treatments that have been shown to work and the trouble is that very few have (as mentioned above) so we are left with injections, straps, therapy and time and surgery if all else fails.