Tennis elbow

Question 1

What is tennis elbow?

Answer 1

• It is lateral epicondyltis of the elbow usually in middle age and commonly noted in carpenters, bricklayers, housewife, gardener, dentist and violinist. Also seen in sportmen who play squash and tennis

Question 2

What are the symptoms of tennis elbow?

Answer 2

• Pain at outer elbow referred down back of forearm
• Rest pain and night pain in extreme cases
• Elbow pain during gripping hand movements such as turning door handles and picking up objects

Question 3

What are the three important physical signs to diagnose tennis elbow?

Answer 3

• Localised tenderness to palpation over the anterior aspect of the lateral epicondyle
• Pain on passive stretching at the wrist with the elbow held in extension and the forearm prone
• Pain on resisted extension of the wrist with the elbow held in extension and the forearm prone

Question 4

What are the management principles for lateral epicondylitis?

Answer 4

• Rest from offending activity and exercises to strengthen the extensors of the wrist are cornerstone of treatment
• A trial of NSAID with RICE is worthwhile
• Wringing exercise using a hand towel is beneficial in chronic tennis elbow-10 sec wrist flexion and 10 sec wrist extension
• Hand held weights or dumbells on a table to strengthn wrist extensors are useful
• Pronating exercise until the painful point is reduced is helpful
• Physio referral is ideal

Question 5

What are the other treatment options?

Answer 5

• Corticosteroid injection reserved for those with severe cases when pain restricts daily activities
• Physiotherapy is the best long term option
• Severe and refractory cases referred to a surgeon for stripping of the common extensor origin with debridement of the granulation tissue
• The course runs 6-24 months