What is it?
It is not a condition commonly associated with tennis! The pain is on the outside of the elbow in the region of the bony prominence called the lateral epicondyle. This is a chronic condition associated with overuse of the tendons attached to the lateral epicondyle. Tennis elbow is a condition similar to golfers elbow in which the pathology is on the inside of the elbow.
History and examination in keeping with chronic use of the upper limb is found with tenderness not only related to the region of attachment but also to the muscle tendon complex attached to the lateral epicondyle. Other causes of pain in this region of the elbow including posterior interroseous nerve syndrome, radiocapitellar degeneration, anconeal pain and tumour need to be excluded as misdiagnosis of tennis elbow will result in failure of treatment.
Radiographs (X-Rays) can reveal bony changes in this region of the elbow
Magnetic resonance imaging can indicate changes in the tendon in keeping with the diagnosis and also delineate other pathology.
Rest and modification of activity is often successful as in many patients this is a self limiting condition although it may take a number of months to resolve. In the cases which persist anti-inflammatory drug and steroid injections are an alternative form of management and it is uncommon for the condition to require surgery.
The operation can be done as a general anaesthetic or alternatively with a local anaesthetic. This is an injection in the neck which numbs the shoulder and arm negating the problems associated with anaesthetic gasses and allows patients to stay awake and watch their operation. If preferred patients can listen to music rather than watch or have a supplementary relaxing injection. It is important to note however that patients having an operation with Martin Holt can have a local or general anaesthetic - its your choice.
The degenerate tissue is excised and the bone freshened to improve healing conditions in the area for the repair of the tendon. Patients have to avoid heavy lifting and repetitive activity of the elbow for six weeks to allow the healing process to take place.
Dressings placed over the surgical incision are retained for 7-10 days. Absorbable sutures are used but these do not require removal as they dissolve over the course of time. Physiotherapy is not usually required the range of motion returning in the couple of weeks following the operation.
Time off work
The time you have off work doing the physiotherapy can vary from two to three months. It is dependent on several factors but importantly on the pathology, rate of healing and your occupation.