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Tennis Elbow and Golfer's Elbow




What is tennis / golfers elbow?
 
Tennis or Golfers elbow is caused by inflammation of the tendons at the side of the elbow (golfers on the inside, tennis on the outside). There are usually small tears within the tendon caused by wear and tear, which becomes inflamed and painful, frequently after excessive or unusual use.
 
What are the usual symptoms?
 
The symptoms are usually pain over the affected area, local tenderness and difficulty maintaining full grip strength because of pain. There may be a small amount of swelling. You may find a lot of activities cause pain, particularly if lifting or holding a heavy weight is involved. You do not need to play golf or tennis to get this condition.
 
There is usually a tender area over the tendon where it joins to the bone at the elbow.
 
What causes it?
 
In most cases the cause is related to excessive or abnormal use, though it can occur without obvious cause. Poor technique or incorrect grip has been implicated in sports players.
 
What are the treatment options?
 
Most cases of tennis / golfers elbow will resolve on their own and no treatment is required. In some cases this may take many months or even a year or two.
 
Treatment can speed up this process and includes anti-inflammatory medication or gels, forearm braces and local physiotherapy to the area.
 
In more persistent cases, cortisone injection can help. This can be performed in the clinic or by your GP and involves an injection of a small amount of cortisone and local anaesthetic into the painful area. Not all cases respond to treatment and further injections may be required.
 
An operation can be done to help this condition, but this is usually left as the last resort. The condition is usually self limiting, and you should not prematurely decide to undergo an operation.
 
What does the operation involve?
 
This consists of releasing, and repairing the inflamed tendon at the elbow through a 3-4cm incision. This can be done as a day case procedure, but usually requires a full anaesthetic. All jewellery, nail varnish and false nails must be removed from the hand of the arm, which is to be operated upon.
 
Will I be able to use my arm after treatment?
 
After an injection, the arm should be moved normally but avoid heavy activity, sport etc for at least 6 weeks.  
 
The injection site is frequently painful for 48 hours after an injection but should gradually improve and by about 2 weeks, significant improvement should be noticed in the majority of cases.  
 
The injection will last for about 6 8 weeks, so further treatment should not be tried until then.
 
If you have had surgery, you will have a bandage on your elbow which will be reduced in size in 3 -5 days but you should not wet your bandage. You will be encouraged to use your elbow gently.
 
Heavy activity, lifting or manual work should be avoided for a least 6 weeks following surgery to allow the tissue treated to fully heal. 


Can the operation do me any harm?
 
The risks of local cortisone injections are extremely small although injections should be limited to a maximum of 3 injections over a 6 -12 month period.
 
In a few cases, some thinning of the skin over the elbow can occur after multiple injections.
 
4
The injections can be painful for 1 to 3 days but this should then subside. Infection is also an extremely rare possibility after injection. 


In those few cases requiring surgery, there is a risk associated with the anaesthetic, but this very small.
 
The wound usually takes 2 -3 weeks to heal and full function may take 6 8 weeks to return.  
 
Infection in the wound can occur but is usually simple to treat with antibiotics.
 
Surgery does not relieve the symptoms in up to one-third of cases.

The Manchester Orthopaedic Group has three hand and wrist surgeons. Steve Royle , Jochen Fischer and Mohammed Waseem are established consultants. They are able to offer a range of treatments for various conditions from carpal tunnel syndrome to wrist arthritis.

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