Tennis elbow is the term used to describe the disabling pain which is felt on the outer aspect of the elbow over the bony prominence. Despite the name, tennis is not the only cause nor is it the most common cause. The pain is often crippling and prevents normal use of the elbow due to both pain and weakness of wrist movements. Pain starts gradually and may not actually be associated with an injury. The pain is nearly always felt on the outer point of the elbow and is made worse by rapid motion of the forearm especially the action of picking up a heavy object or striking a backhand shot at tennis. It does not improve as the elbow is warmed up. When this pain is felt on the medial (inner) side it is called golfers’ elbow or medial epicondylitis.
There are many treatments currently in vogue for this problem. Physiotherapy, massage, muscle stretching and isometric strengthening and associated use of anti-inflammatory medications often are quite effective at relieving the pain. Other treatments are liniment rubs, neoprene compression bandages in the forearm and ceasing sporting activities. As with any condition that has lots of different treatments, many patients fail to experience relief with any of them and give up in frustration.
If you have had any or perhaps all of these treatments and are no better, you have fallen into that group of patients whose pain is due to “lateral epicondylitis”. This term describes the tissue which is affected by this condition. Pain, which is often severe, is on the outside area of the elbow (lateral epicondyle) or on the bony prominence near the “funny bone” (medial epicondyle). Severe local tenderness is felt when the area is pressed and can make any elbow motion painful. Loss of power results in difficulty lifting even light objects.
Attached to the elbow at these points is a structure called the “common extensor origin” or “common flexor origin”. There are four important muscles attached here laterally and five medially and all are important to the normal function of the forearm and the wrist. Over time, wear and tear in these areas results in degeneration of the tendon attachments and microscopic failure of the individual bands of the tendon. As scar forms in response, it prevents the tendon from reattaching and eventually the tendon breaks off the bony attachment completely. This causes severe pain and weakness.
When the tendon is torn, Cortisone and oral medication may help the pain a bit but the effect is short lived because it won’t specifically deal with the problem of the tear. This explains why so many of the conservative treatments result in a disappointing degree of longer term pain relief. When all these treatments fail, the pain can reliably be relieved by an operation.
Even long-standing tennis elbow pain can be reliably relieved by surgery. There is no duration of symptoms when the surgery becomes ineffective. Most patients are comfortable enough to use the elbow normally by six weeks post-surgery but most patients also note that their long-standing pain is gone immediately even if it is temporarily replaced by the bruising type pain from the operation. This operation pain is short lived. Importantly, elbow mechanics are maintained and the pain relief is permanent.
Read about Reconstruction of common extensor origin
Read about Reconstruction of common flexor origin