Tennis Elbow (Extensor Tendon Tendinitis)

Tennis elbow is a chronic over use inflammatory/degenerative condition of the origin of the wrist extensor tendons which arise from the bone on the outer (lateral) side of the elbow.

As its name suggests, tennis elbow can affect tennis players, as well as many other people who repetitively stress the wrist extensor tendons such as manual laborers, sports people, and musicians and is most common between the ages of 35 and 55 years.

Anatomy
The elbow joint consists of the three arm bones - the humerus (upper arm bone) and the radius and ulna (lower arm bones). Ligaments attach the bones to each other and muscles are attached by tendons to the bones. The end of the humerus has two epicondyles or bony projections to which the tendons attach.

When the extensor tendons attached to the outer (lateral) epicondyle of the elbow become inflamed and painful, this is known as lateral epicondylitis, or more commonly, Tennis elbow.

Non-operative Treatment
Anti-inflammatory medication or other analgesics may be prescribed for pain relief. Avoid or modify activities that aggravate the pain. Applying ice to your elbow after heavy use may provide some relief. A wrist support may be useful in helping to keep the wrist neutral, lessening the stress on the tendons involved, whose function it is to move the wrist backwards.

A cortisone injection into the tendon may be suggested to help reduce pain, inflammation and swelling of the tendon. If conservative measures are unsuccessful in treating the condition, surgery may be indicated.

Operative Treatment- Percutaneous Tenotomy of Extensor Tendon
Description
A simple procedure used to release the extensor tendon through the skin. This is achieved by using a needle and can be attended in the consulting rooms under local anaesthetic.

The sharp bevel of the needle is used as a mini-scalpel to cut the involved tendon. This induces an acute injury which encourages the natural healing process.

Post-operative Treatment
Following the procedure, you will have a small dressing and bandage on your elbow and wear a wrist support splint. You can remove the bandage a few hours after the procedure, once you are at home. Wear the splint continuously initially and increase activities out of the splint as your pain allows. Full healing will take 6 weeks.

The local anaesthetic usually has an effect for about 12 hours. After this time, simple analgesia such as paracetamol is enough to relieve any pain you may have; you may also be prescribed anti-inflammatory medication.

Practice Perspective
This technique has been my standard for the last 10 years. The results achieved are equal or superior to those from open surgery, as reported. I have completed a paper on this technique, with the results prepared for presentation and publication. This is confirmed by comparison of reviewed results of the percutaneous technique and results of various arthroscopic and open surgical techniques in the Orthopaedic literature.

Lakhey S, Mansfield M, Pradhan RL, Rijal KP, Panday BP, Manandhar RR. "Percutaneous extensor tenotomy for chronic tennis elbow using an 18G needle." Kathmandu University Medical Journal, 2007.

Autologous blood injection (where a small amount of your blood is re-injected into the affected area) is a recent treatment option that is also being used, but my experience with this technique has not been rewarding and I no longer use this method.

Risks/Complications
Sometimes it is necessary to repeat the procedure to completely alleviate the problem, as multiple areas of tendon involvement may not be treated at the initial surgery.

Apart from the need to repeat the procedure and an eventual small number of cases requiring open surgery, there have been no complications to date.