These are very common conditions known usually as tennis or golfer’s elbow. The former relates to tendon irritation on the outside of the elbow. The latter relates to irritation on the inside of the elbow or medial epicondyle.
While the pain is felt around the elbow, these muscles actually move the wrist and fingers. While an acute injury can trigger these phenomena, the cause is usually a repetitive strain injury or a relative increase in demand on muscles that are not strong or fit enough to tolerate it. Good examples are increased activity in the garden after the winter break or increased amount of golf when on holiday.
While there are many different treatments, the key is good rehabilitation. Injections have varying support in the published literature on the subject but in general can be interpreted as having a role in facilitating rehab. It is also important to remember that one cannot turn back the clock on the condition; the goal of treatment is to control the symptoms to the point where they are either absent or have minimal day to day effect. The diagnosis is a clinical one, but plain x-rays, MRI or CT scanning may be required to rule out other causes for pain.
We usually recommend anti-inflammatory medication and physio as a first line. This can include many modalities including ultrasound, acupuncture and others but the key element is eccentric strengthening. Injections of either steroid or protein rich plasma (PRP) to facilitate rehab are the next step. The number of these injections it is safe to give is limited so a very small group, perhaps 1% of patients, come to surgery if their symptoms do not settle.
If a steroid injection is appropriate, we can usually provide this for you at the time of your consultation. Should you require PRP, we will refer you to our colleagues in the sports centre where the equipment for these injections is readily available. Physiotherapy to strengthen the muscles and add endurance then follows. Sometimes splinting of the wrist to rest the muscles between physio sessions can be useful, and while support for elbow braces is variable, some people find it helpful.
In my hands, surgery involves an arthroscopic (keyhole) procedure. While no difference in outcome between arthroscopic and open techniques has been proven, the arthroscopic option does allow a thorough examination of the joint to rule out other causes of elbow pain which may be behind the pain not settling with active conservative management.
During your consultation, I will examine you and discuss your options. It’s good to know that with patient and diligent rehabilitation, facilitated by pain relief and injections, surgery is rarely required.
Information on surgical interventions can be found here.
In the few cases that do need surgery, we encourage early motion. While there will be some early restrictions on what you can tolerate, early rehabilitation is important.
Physios: see our therapy guidelines for post-operative care