Tennis Elbow

Tennis ElbowTennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow. Tennis Elbow is a common cause of lateral sided elbow pain. Contrary to the given name, many sufferers of tennis elbow do not necessarily play tennis.

The diagnosis is usually straight forward. The area of the tennis elbow pain can be identified with one finger and it is usually on the outer bony prominence of the elbow. This pain is worsened by extending the wrist against resistance with the elbow straight.The person suffering from tennis elbow will have difficulty lifting heavy loads and many simple activities of daily living can potentially trigger the pain as the wrist joint usually need to be extended during most activities.

Symptoms

The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.

Common signs and symptoms of tennis elbow include:

  • Pain or burning on the outer part of your elbow
  • Weak grip strength

The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however both arms can be affected.

Tests

Your doctor may recommend additional tests to rule out other causes of your problem.

X-rays

These may be taken to rule out arthritis of the elbow.

Magnetic Resonance Imaging (MRI)

If your doctor thinks your symptoms are related to a neck problem, an MRI scan may be ordered. This will help your doctor see if you have a possible herniated disk or arthritis in your neck. Both of these conditions often produce arm pain.

Traditional Surgery

The traditional surgery for tennis elbow involves a 3 to 4 cm incision over the outer aspect of the elbow centred over the painful area and the diseased tendon causing the pain (called the ECRB tendon) is found after cutting through normal ECRL muscle and tendon.

Tennis Elbow2

The elbow will need to be rested in a splint for about 2 to 3 weeks. The person is unable to work for about 2 to 3 weeks.

I prefer a minimally invasive key-hole surgery approach.

Arthroscopic Treatment of Tennis Elbow

This procedure is done under general anaesthesia and it takes about 25 to 30 minutes to complete. It involves making 2 small puncture holes (about 3mm in size) on either side of the elbow joint. A small TV camera (called the arthroscope) is inserted into the elbow joint from the inner aspect. A 2nd small hole is made on the outer aspect of the elbow joint to allow a shaver device to be inserted into the elbow joint.

This shaver allows me to remove a small portion of the joint capsule to expose the diseased ECRB tendon near the insertion into the lateral epicondyle. The diseased ECRB tendon is carefully removed with the shaver. The elbow can be moved almost immediately after this surgery. The time off from work is markedly reduced from a couple of weeks to just a few days.

Rehabilitation

Following surgery, your arm may be immobilized temporarily with a splint. About 1 week later, the sutures and splint are removed. After the splint is removed, exercises are started to stretch the elbow and restore flexibility. Light, gradual strengthening exercises are started about 2 months after surgery. Your doctor will tell you when you can return to athletic activity.