What is tennis/golfer’s elbow?Tennis elbow, also known as lateral epicondylitis, is a condition that affects the forearm muscles that attach to the outer aspect of the elbow. Golfer’s elbow, also known as medial epicondylitis, is a condition caused by the same process but affecting the forearm muscles which attach to the inner aspect of the elbow. Both conditions are related to strenuous or repetitive activities that affect these muscles. Often this is a result of your occupation or a hobby and doesn’t necessarily have to involve tennis or golf!
The affected muscles in tennis elbow are those on the back of the forearm that work to bend the wrist back, and in golfer’s elbow, the muscles on the under side of the forearm that work to bend the wrist down and make a fist. Repetitive over use of the tendons of these muscles close to where they are anchored to the bone at the elbow produces small tears within the tendon. These tears in the tendon are then unable to properly heal, often due to ongoing injury from over use activities. Less commonly these conditions may be triggered by one single injury, rather than a gradual build-up from prolonged over use.
Tennis elbow is approximately five times more commonly seen than golfer’s elbow.
What are the symptoms and signs?The common complaint is of an aching discomfort over the outer (tennis) or inner (golfer’s) side of the elbow and forearm, particularly with activity. The area near to where the tendons attach to the bone is often tender to touch or if knocked. In more severe cases there may be aching and pain at rest, or with straightening of the elbow.
How is tennis/golfer’s elbow diagnosed?The diagnosis is most commonly confirmed in the outpatient clinic based on clinical assessment. In cases with a preceding history of an injury, or very longstanding symptoms, an ultrasound or MRI scan can identify if there are any larger tears in the tendon.
How is it treated?Most patients’ symptoms will settle within 12 months if they are able to rest and modify their activities; this stops the repetitive insult to the tendons involved and allows them the opportunity to heal. Physiotherapy with stretching exercises to the affected tendons is often helpful, and this can often be used in conjunction with a padded clasp to offload the tendons during certain activities with good affect.
Local anaesthetic and steroid injections have long been used for both tennis and golfer’s elbow; however it appears as though they do not help in the longer term. They may sometimes still be appropriate for short-term pain relief prior to a specific important event, accepting that the affect will probably wear off after a month or two.
Other treatments are generally reserved for cases that do not respond to the above measures, and aim to try and “kick-start” the healing response within the injured tendon. The first method of trying to achieve this is to use Platelet Rich Plasma (PRP) injection. This is usually performed in theatre as a day-case local-anaesthetic (awake) procedure; a blood sample is taken from a vein in the arm using a special syringe and then spun very quickly in a machine to separate out the red blood cells from the platelets and plasma. The platelet and plasma fluid can then be reinjected into the injured tendon to promote a healing response in the tendon. It often takes two to three months for an improvement in symptoms to occur and the best results are seen in conjunction with trying to rest the arm as much as possible in the first four weeks following the procedure.
Surgery is usually reserved for cases where all the above treatments have failed to sufficiently improve a patient’s symptoms – only approximately 75% of patients’ pain will resolve following surgery. In both tennis and golfer’s elbow surgery, the aim is to try and remove any abnormal, unhealthy tendon, so that the remaining tendon is able to heal. In tennis elbow this can be performed as either an open or keyhole (arthroscopic) procedure, in golfer’s elbow it is an open surgery. All procedures can be performed as day-case surgery under either a general anaesthetic (asleep) or regional anaesthetic (arm numb but awake).
What are the potential complications?The more general risks associated with surgery are low in terms of infection, bleeding or damage to local nerves. There is a very small risk of instability of the elbow if too much tissue is removed from the outside of the elbow so that it compromises the small strap that stabilises that side of the joint. Statistically, the most common problem following surgery is incomplete relief of pain.
What rehabilitation is necessary after surgery?It is advisable to try and rest as much as possible in the first month following surgery or PRP injection and it is often six weeks before the patient will be back doing most day-to-day activities without pain. Driving is possible when comfortable and safe to do so, this will often not be until two to four weeks following surgery.
A big thank you to Simon and his team for their care, patience and perseverence looking after me through all stages of both shoulder and elbow surgery.
Since the shoulder stabilisation I have continued my sailing and fitness training without the worry that my shoulder might dislocate; and I don’t have to think twice whether my ulnar nerve will hinder any progression in my sports.
With their amazing help, I’ve been able to get back to sailing competatively and am now a double National champion.
After multiple shoulder dislocations Charlie helped me set a route for recovery, which has been nothing but smooth sailing. Surgery went successfully and I am well on my way to playing the sports I was previously. Would highly recommend.
Simon successfully operated on my frozen left shoulder in 2012 with fantastic results. This year he has overseen and advised treatment for my frozen right shoulder (via hydrodilation injection). His unrivalled experience in orthopaedic shoulder treatments, coupled with his reassuring bedside manner and excellent results, gave me huge confidence throughout. I’m hugely grateful to have my quality of life back and wouldn’t hesitate to recommend his services. Thank you Simon.
I had suffered with a painful shoulder and pins and needles for three years following a right shoulder fracture and failed half joint replacement prior to meeting Mr Pennington. He explained the situation in a way I could relate to and I’m delighted to say my revision shoulder replacement has gone well and for the first time in years I can use my arm and am pain free. I was even able to walk my daughter down the aisle 3 months after surgery! Many thanks.
I would like to thank Charlie Talbot and his team for the operations performed on both my shoulders and also the aftercare put in place after my operations. I have played golf since I was 12 years of age and thought at one point that I would never get back to playing again. Charlie was always very positive and told me that he would get me playing golf again. Well, I have now been playing golf for nearly 2 years. Before surgery I had a handicap of 12 and I am now down to 9, not bad at the age of 68. So many many thanks.
I had PRP injections into my right elbow last year and within 3 months I was pain free, a year on it is more or less 100% better. Fabulous I would recommend it to anyone with Tennis Elbow, in fact I have gone back again this year to get my left elbow done. Thanks Simon.
Mr Pennington I really wanted you to know how very thankful I am for the excellent care & treatment you and your staff gave me. It really meant a lot that you were so clear, friendly & professional and listened to me – so thank you again.
After more than four decades of shoulder problems with a total of three surgeries the full shoulder replacement surgery by Mr. Talbot has changed my life beyond expectations. I am now able bodied for the first time in years and pain free.
Thank you to Mr Boyle and team for the excellent care and attention both before and after Replacement Shoulder surgery, using the Tornier Simpliciti procedure. After very many months of severe pain and lack of movement I was pain free from day one. Now, after nine weeks, the shoulder and arm movement continues to improve, beyond expectation, with physiotherapy and exercise. I am extremely grateful for all the continuing care.
Following two years of recurrent problems with my left shoulder I was recommendedto Consult Mr Neil Pennington. I had the opportunity to have my surgery quickly and at my convenience, this fitted well around my professional and home commitments. The surgery was carried out as a day case procedure and Mr Pennington visited me following the surgery to explain everything. My operation was a minimally invasive procedure so my recovery was straightforward with only a few restrictions; in fact I was encouraged to keep my shoulder moving. I was driving and back to work after 2 weeks – after 2 years of pain and sleep disturbance I found this operation to be life changing! I found Mr Pennington to be a very professional and compassionate surgeon and he is surrounded by a whole team of professionals that gave me the utmost confidence in the care and treatment I received.
I would like to thank Mr. Talbot and the amazing team of nurses, physiotherapists and support staff for their care and support during my recent visit to the Duchy Hospital, Harrogate, for a replacement shoulder. The care and attention I received was unparalleled. The pain free movement I now have has changed my life.