Tennis Elbow

Tennis elbow does not have distinct medical subtypes, but it can be described as either

• Acute tennis elbow is a condition where pain develops suddenly, usually after an injury or episode of overuse.
• Chronic tennis elbow is a condition where pain persists for a long time due to repeated strain on the tendon.

People with tennis elbow usually experience pain and weakness around the elbow and forearm that may interfere with daily activities:

• Pain on the outer aspect of the elbow, especially while doing activities such as twisting, gripping, or lifting heavy weights.
• Pain sometimes radiates down to the forearm or wrist.
• Weakness in grip strength or difficulty holding objects.

The exact cause for this condition is unclear, but several factors increase the risk:

• Repeated overuse of the elbow, such as those during screwing, typing, knitting, or racquet sports.
• Underlying medical conditions such as diabetes, thyroid disorders, or conditions like rheumatoid arthritis.

Diagnosis is usually based on a physical examination and may be supported by imaging tests:

• The doctor may perform specific clinical tests, such as Cozen’s test, to reproduce pain at the tendon.
• X-rays help to rule out fractures, bony spurs, or even calcifications.
• Ultrasonography may be used to check the integrity of the tendon and attached muscles.
• Magnetic resonance imaging (MRI) provides additional information, especially in severe or unclear cases.

Treatment for tennis elbow can be either non-surgical or surgical depending on severity and response to therapy.

• Non-surgical treatment is usually the first step.
  • Patients are advised to make lifestyle modifications, such as avoiding heavy weights activities and limiting twisting movements at the elbow.
  • Applying ice packs on the affected area to reduce the inflammation (swelling) and pain to a larger extent.
  • Commercially available splints or straps can help reduce the strain on the tendon and promote the healing process.
  • Stretching and strengthening exercises to strengthen the whole muscle-tendon unit, including the elbow and wrist joints.
  • Local injections, such as steroids and platelet-rich plasma (PRP) may provide relief and promote tendon repair.
• Surgical treatment is considered when symptoms persist despite several months of non-surgical care:
  • Mini-open surgery involves making a 3–4 cm incision over the outer aspect of the elbow joint and removing the unhealthy tissue, and repairing the damaged portions.
  • Arthroscopy is a newer technique that helps in addressing the pathology with 2–3 small incisions releasing the pressure on the tendons and removing the unhealthy tissue.
• After surgery, wound care is essential for 2 weeks and maintaining the arm in a sling.
  • Based on the type of repair done, the rehabilitation usually starts 2 weeks after surgery.
  • Complete recovery is expected by the end of 2–3 months.

A person should seek medical advice if pain persists for more than a few weeks despite rest and home care, if the pain interferes with daily activities, or if weakness in the arm is worsening.

Tennis elbow can often be prevented with a few lifestyle measures:

• Use proper technique when lifting or playing sports to avoid excess strain on the elbow.
• Take regular breaks during repetitive activities.
• Perform stretching and strengthening exercises for the forearm and wrist.
• Use supportive equipment, such as straps or braces, especially while playing racquet sports.

Patients can first consult a general physician for assessment. Persistent or severe cases may require referral to an orthopaedic specialist or a sports medicine doctor. A physiotherapist plays a key role in rehabilitation and long-term prevention.