3 August: Q&A with Mr B Venkateswaran

I’m a keen tennis player and normally play twice a week, but I’ve started having problems with recurring pain in my right elbow, which worsens when I lift or bend my arm. I’ve tried resting for a week or two, but every time I play the pain and swelling come back. Do you think this might be tennis elbow?  Is there something more effective I can do? I’d hate to have to give up my game.

Mr B Venkateswaran, Consultant Orthopaedic Surgeon, Spire Leeds Hospital

Firstly, you should seek help from your GP to establish the diagnosis, as there are other problems around the elbow that can mimic “tennis elbow”.

Assuming your diagnosis is correct, let me assure you that most people are able to get back to playing sport after appropriate treatment.

Tennis elbow afflicts the common extensor muscle origin from the bony prominence on the outside of the elbow. It is a lack of healing response of the tendons attached to bone, rather than the inflammation itself, that brings on the pain. Pain is typically activity related, such as a sharp stabbing sensation to dull ache felt in the outer elbow when lifting a weight, but can also affect rest periods and nighttime sleep.

Painkillers can help but should be combined with an initial period of rest for four to twelve weeks and stretching of the muscles in the forearm. Hot or cold compresses can help. All of these can be better delivered under the watchful eye of a physiotherapist or your doctor. It is imperative to warm up and stretch before any activity.  With such an approach most cases of tennis elbow settle in time.

If the condition does not settle down over three to six months, an early injection of a long acting steroid and local anesthetic can be given around the tendon to relieve the pain. Injections are repeated typically every three to six months if required.

In severe or persistant cases, a surgical referral may be necessary, where other treatment options can be discussed including shock wave therapy in selected cases or very rarely surgery itself. 

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