Tennis elbow is very common. A lot of work has been done on what exactly is going on to cause this typical pain at a well localised point on the outer side of the elbow. It is almost certainly a tendinopathy close to where the tendon of the extensor carpi radialis brevis tendon attaches to the outer side of the elbow. This is a tendon which runs across the wrists and whose function is to cock the wrist back. Tennis elbow can be initiated by an acute injury, but more commonly the onset is insidious. It is usually not a disabling pain, more of an annoyance. Sometimes it is caused by using an inappropriate tennis racket grip which is either to big or more commonly too small. Adjusting the size of the grip may be therapeutic.
The mainstay of treatment is rest, non steroidal anti inflammatory drugs and physiotherapy, particularly cross frictions, but a number of modalities have been tried. The other non invasive approach is the wearing of a tennis elbow clasp which is a band around the top of the forearm which unloads the unhappy area of tendon.
Should this fail a steroid injection (“cortisone”) will often take the heat of the situation, but there is precious little evidence that it makes any difference in the long term. A number of other therapeutic alternatives have been tried recently including manipulation under anaesthetic and there has been a lot of publicity for shock wave treatment in order to break up the injured area of tendon. Extracorporeal shock wave therapy is a very effective and safe new treatment for certain tendonopathies, but requires rather expensive & specialised equipment. We now have access to this routinely and are starting to see the benefits.
If all else fails, then there is an operation which has a high success rate, but it should be reserved for cases resistant to all other treatments. The vast majority will settle with a combination of non operative treatments over a period of 6-12 months and we try and avoid surgery whenever possible
Golfer’s elbow is a similar condition, but on the inner side of the elbow and associated with the tendons that run to the front rather than the back of the wrist. It is often associated with tingling in the little finger since the ulnar nerve passes adjacent to the inflamed area. This is the “funny bone” and sometimes patients complain of electric shocks and irritability of the area at the back of the elbow.
More serious conditions of the elbow are uncommon without major trauma in this country although our colleagues in America have extensive experience in the treatment of over use injuries in base ball pitchers. Repetitive pitching places enormous stresses in compression across the outer side of the elbow and in tension across the inner side of the elbow and either side may fail. Most commonly the soft tissues on the inner side need tightening up or reconstructing to prevent this instability.
I have recently seen several elite athletes including several super league rugby league players with a torn biceps tendon at the elbow. This injury is caused by a direct blow to the tendon when it is maximally tensed. Rupture of the biceps tendon at the shoulder does not usually need an operation, but I do recommend surgery for an injury at the elbow, since the evidence is very string that without surgery, the patient is left with a permanent weakness, both of the bend, but especially of the twist of the elbow.