Tennis elbow

Tennis elbow is a degenerative condition of the tendon fibers that attach on the bony prominence (lateral epicondyle) on the outside of the elbow. It is also known as 'lateral epicondylitis' . The exact cause of tennis elbow is not known, but it does tend to occur after repetitive use of the Common Extensor Tendon such as in tennis (hence the name) and happens mostly in patients between the ages of 30 - 50 years.

The first sign of tennis elbow is usually tenderness and pain when pressure is applied to the lateral epicondyle and a dull constant pain or sharp shooting pain may be felt during activities such as lifting a heavy object or shaking hands. Swelling may be present. A general weakness and deconditioning of muscles in the affected arm may be noticed. The timescale for recovery from Tennis Elbow may vary from 6 months to two years.

Treatment

Treatment of tennis elbow involves:

Rest - This does not mean total rest but a period of time avoiding those activities that specifically aggravate your pain. Your physiotherapist will show you how to move to keep your elbow working but to avoid pain

Painkillers and anti-inflammatory medications which will have been prescribed by your GP/Doctor

Physiotherapy - This involves restoring pain-free movement in your elbow and reconditioning the muscles not only around the elbow but within the whole upper limb. If you have a lot of stiffness/ pain in your elbow or associated neck/upper back pain you may need one to one treatment.

However the most important part of treatment is your home exerciseprogramme. You will be shown a series of exercises to do either in a group setting or one to one setting

Remember: Understanding your problem is key to your recovery so if anything isn't clear please ask your physiotherapist

Injections - These may provide relief of acute symptoms but there is some evidence that the overall course of the condition may be unaltered or even increased.

Surgery - Occasionally some patients do not respond to the Physiotherapy Programme and so Surgery is required - the goal of any surgery is to reduce pain and increase range of movement.  The operation usually performed is called a Lateral (Tennis elbow) Release of the Elbow and involves a small incision over the lateral epicondyle area and separation of the common extensor origin from the lateral epicondyle.

What are the risks of having a Tennis Elbow Release?

All operations involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time.
The risks are:

• Complications relating to the anaesthetic
• Infection
• Persistent symptoms - the operation is said to be successful in approximately 80% of patients.

What sort of anaesthetic will be given to me?

You will be given a general anaesthetic. General anaesthesia is drug-induced unconsciousness: it is always provided by an anaesthetist, who is a doctor with specialist training.

Unfortunately, general anaesthesia can cause side effects and complications. Side effects are common, but are usually short-lived: they include nausea, confusion and pain. Complications are very rare, but can cause lasting injury: they include awareness, paralysis and death.

The risks of anaesthesia and surgery are lower for those who are undergoing minor surgery, and who are young, fit, active and well.

You will be given an opportunity to discuss anaesthetic options and risks with your anaesthetist before your surgery.

The day of your operation

• This is a day case procedure i.e. admission and discharge on the same day.

• If you are on regular medication, you will be told to take this if necessary.

• A nurse and porters will take you to the operating theatre.

• Your dentures, glasses or hearing aid can stay with you on your journey to the operating theatre.

• When you arrive in the waiting area, a theatre nurse will check your details with you. You will then be asked to put on a disposable hat. The ward nurse will then leave you and you will then be taken to the anaesthetic room.

What should I expect after my operation?

• After your operation you will be kept in the theatre recovery room before being transferred to the ward.

• A nurse will check your pulse, blood pressure, and breathing rate regularly.   It is important that if you feel any pain you must tell the nursing staff, who can give you painkillers to help.

• The nursing staff will also advise you when you can start taking sips of water. Anaesthetics can make some people sick. If you feel sick we advise you not to drink until this feeling has passed. The nursing staff may offer an injection to help this sick feeling go away.

Going Home

Your doctor will normally discharge you on the same day as your surgery.  You will remain in a sling for approximately one week to rest the elbow.
For recreational tennis it is usual to start easy stokes 6 to 12 weeks after surgery.

Discharge Information

Pain relief & medication
The nursing staff will advise you about painkillers before you leave the hospital. Please tell the nurses what painkilling tablets you have at home.

Your wound
Your wounds must remain covered with dressings until your outpatient appointment, where your sutures will be removed.

Getting back to normal
Remember that you have just had an operation. It is normal to feel more tired than usual for a few days after having an operation.
Your elbow  is likely to be uncomfortable in the first few days post-surgery. This is normal but can be helped by;
It is important to remember that the majority of patients get better with Physiotherapy guidance and their home exercise programme!