Tennis and golfer’s elbow are painful conditions (tendinopathies) of the outer and inner aspect of the elbow respectively. The pain originates in degenerative tendon tissue, rather than inflammatory tissue, with micro tendon tears occurring. They are often associated with overuse.
The initial treatment of these painful conditions is rest, activity avoidance and pain killers. In more resistant cases steroid injections, platelet rich plasma injections, physiotherapy and surgery are considered.
Steroid injections have been shown to provide pain relief in the short term (first 6 weeks) but there in an increased risk of relapse of symptoms in the longer term. Steroid injections may have a role therefore in relieving acute pain to allow patients to undertake a period of physiotherapy, but the use of steroids has been questioned recently. There is research that shows a worse outcome at 1 year following treatment with steroid compared to placebo.
Physiotherapy has been shown to be effective in the treatment of elbow tendinopathy. Loading the tendon as the muscle lengthens (eccentric exercise) is the mainstay of therapy, and this has been shown to be effective in relieving pain, as well as improving grip strength and function, and leading to better long term pain relief than steroid injections alone.
Platelet rich plasma (PRP) injections are an interesting alternative. Similar to a blood test, blood is taken from the patient and placed into a centrifuge system that spins the blood, separating it out into its component parts. The platelet rich plasma is then re-injected in to the tendon under local anaesthetic. Anti-inflammatory medications are avoided for 10 days before and 2 weeks after injection, so that an inflammatory and healing response can take place. Some pain and swelling (and even bruising) can occur, though this tends to settle within a couple of weeks.
There is evidence that both supports and shows no benefit in PRP, and as such not all insurance companies fund this treatment. Reviewing my personal experience has shown that over two-thirds of patients improve by 75-100% (pain scores and quick DASH scores), and I therefore offer this as a treatment option. Post injection physiotherapy is restarted at 4 weeks.
Surgery for tennis elbow is reserved for persistent and chronic cases. A surgical release is performed as a day case either through a small incision or by keyhole surgery. Overall, good results are achieved in 75-80% of patients.
Evidence based physiotherapy treatment with eccentric exercises can be found in the Rehabilitation section.