Continuing our hugely popular medical column, Medical Matters, this week Dr Ciaran Roarty of Scally/McDaid Medical Practice explains the condition of Tennis Elbow and how it can be treated.
Tennis Elbow is a condition where you feel pain on the outer part of your elbow. Mostly the pain happens when we are actually using our forearm and wrist for turning and gripping movements – for example turning a door handle etc. Sometimes the pain is present all the time. Some people may feel pain further down the arm towards the wrist and gripping a fork or pen may be difficult.
The site of the pain is where the extensor tendons of your wrist (ie the tendons that allow you extend your wrist back) attach to the bone close to your elbow and most people find that their dominant arm is affected.
The pain is caused by swelling of the tendon and is usually as a result of overusing the muscles of your forearm in a repeated way – eg wringing out clothes or using a screwdriver. Playing tennis only actually accounts for a very small percentage of cases!
How common is it?
Tennis elbow is quite common – about 2 or 3 people per hundred will get it, and the usual age group is between 40 to 50 with men and women affected equally. It is more likely if your forearm muscles aren’t particularly fit and you suddenly start using them a lot – for example DIY or playing tennis. But even if you are used to manual work, a little over exertion or a lot of repeated twisting and gripping can cause it to flare . In some people no particular action can be identified as a trigger.
How will your doctor diagnose tennis elbow?
Discussing your symptoms and a physical examination will usually point to the diagnosis. Tests are not usually required unless your tennis elbow is not improving with treatment.
1. It makes sense to try to cease the actions that bring on the pain ie the twisting or gripping movements. Resting from these activities allows the tendon to heal. For some people identifying the activity involved and modifying their movements or cutting out repetitive movements may be sufficient to allow the tendon to heal. You may need to talk to your employer if a work related activity is triggering your tennis elbow to see if tasks can be modified to help you get better.
2. Pain relief
Ice packs (wrapped in a towel) twice a day for 10 to 15 minutes can help. Paracetamol and anti-inflamatory medication such as ibuprofen are also commonly used. These also come in creams or gels and your doctor may prescribe these to avoid some unwanted side effects from longer term tablet use.
3.Physiotherapy does help. Procedures such as massage, laser therapy and ultraound therapy along with tailored exercise programmes designed by you chartered physiotherapist are helpful
4. Supports and splints may be suggested by your physiotherapist.
5.Steroid injection. This tends to be considered if the above measures fail. It tends to work in the short term but unfortunately for some people the pain returns after a number of weeks. The steroid injection may be repeated once or twice but steroids have their own complications/side effects if used repeatedly.
There are other less frequently used treatments for resistant cases to the above treatments and surgery may be required for a very small number of patients with tennis elbow.
Will it go away?
Resting your arm and avoid triggering activities that bring on your symptoms along with some painkillers will result in tennis elbow symptoms settling for most people. However it can last from 6 months up to 2 years and unfortunately for some people it can come back.
Can I stop it coming back?
Increasing the strength of your forearm muscles can help prevent a recurrence and physiotherapists will help guide you with this. It is suggested to stengthen the muscles but avoid the twisting activities that can cause pain. A professional coach may be required if your tennis elbow is brought on by sporting activities in case your technique needs refinement.