Tennis / Golfer’s Elbow

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What is tennis / golfer’s 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.

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?
It is probably due to age related changes in the strength of the tendon.

What are the treatment options?
Some cases of tennis / golfers elbow may resolve on their own and no treatment is required. In the majority of cases this will eventually occur, but 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 is
recommended. This can be performed in the clinic or by your GP and involves 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 a last resort. The condition is usually self-limiting, and you should not prematurely decide to undergo operation.

What does the operation involve?
This consists of releasing, and repairing the inflamed tendon at the elbow through a 2-inch incision (cut). This can be done as a day case procedure, but usually requires a general anaesthetic.

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 six weeks. The injection site is frequently painful for 48 hours after the injection but should gradually improve and by about 2 weeks, significant improvement should be notices 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 then be encouraged to use your elbow gently. Heavy activity, lifting or manual work should be avoided for at 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 should be limited to a maximum of 2 to 3 injections over a 6 to 12 month period. In a few cases, some thinning of the skin over the elbow can occur after multiple injections. The injections can be painful for 1 to 3 days but 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 is 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. Even surgery may not get rid of the symptoms in about one-third of cases.

What happens next?
Your name will be placed onto the waiting list. You may be required to attend for a pre-assessment before your operation.
• Pre-assessment – to make sure you are well enough for the operation. You will also receive more information about the arrangements for coming into hospital and what you will need to bring
with you.

If, whilst on the waiting list, you feel you no longer need this operation speak to your family doctor in the first instance and secondly let the Admissions Office at the hospital know by calling telephone number 01908 996798.