Tennis elbow – onset, symptoms, and surgical treatment

event 25.04.2023.

Tennis elbow, also known as lateral epicondylitis, is a painful condition that occurs when the tendons that connect the muscles of the forearm to the outside of the elbow become inflamed. The term “tennis elbow” comes from the fact that this type of injury often occurs in people who play tennis because the muscles of the forearm are used a lot in that sport, especially in serves and backhands.

The starting point of the muscles that are inflamed, especially the extensor carpi radialis longus, is where the most pain of a tennis elbow originates from. Other muscles often associated with the tennis elbow are the supinator muscle, the extensor digitorum, and wrist extensor muscles. Like the radialis longus, these muscles also work to move the arm and forearm outward, which can put excessive strain on the tendons that connect to the outside of the elbow.

Symptoms of tennis elbow include pain on the outside of the elbow that may spread to the forearm and wrist. The pain usually occurs during activities that involve squeezing, lifting, or rotating the arm. You may also experience forearm weakness, reduced mobility, and sensitivity to touch.

Lateral epicondylitis can occur in people who engage in activities that involve repetitive movements of the hands and forearms, with the following professions being especially vulnerable:

  • tennis players and other athletes who use a racket, such as badminton or table tennis
  • construction workers and craftspeople who use hammers, hand saws, sandpaper, and similar tools
  • workers in the IT sector who spend long hours typing on the keyboard and moving the mouse
  • musicians who play instruments such as guitar, violin or piano
  • gardeners and farmers who perform work that requires repetitive hand and forearm movements
  • hairdressers and beauticians who repeat hand movements when cutting hair, coloring hair or doing facials.

Treatment for tennis elbow usually involves rest and avoiding activities that cause pain, applying ice to the affected area, physical therapy, and the use of anti-inflammatory medications. In more severe cases, there may be need for infiltration and even surgery.

It is important not to ignore the symptoms of tennis elbow because without treatment they can become chronic and lead to further problems with the forearm and joint. If you notice any of these symptoms, we advise you to get examined by an orthopedist in order to start treatment and avoid further injury.

Platelet-rich plasma (PRP) therapy has become popular in the treatment of various sports injuries, tennis elbow included. In the PRP procedure, the doctor takes blood from the patient and centrifuges it to separate the plasma, which contains a high concentration of blood platelets. This plasma is then injected back into the injured part of the patient’s body to stimulate new cell and tissue growth. For tennis elbow, PRP therapy is used to reduce inflammation and pain in the affected area, and promote healing of tendons and ligaments.

Surgical treatment of tennis elbow is usually considered after conservative treatment methods, such as rest, physical therapy, orthotics, pain medication, and corticosteroid injections, are no longer effective in relieving symptoms.

Surgery to treat tennis elbow involves removing the damaged or inflamed tissue around the outside of the elbow. Two types of surgery are commonly performed for tennis elbow:

  1. Traditional open surgery (lateral epicondylectomy): This is the most common procedure used to treat tennis elbow. During the procedure, the surgeon cuts out the damaged tissue and can make minor corrections to the tendons and muscles.
  2. Arthroscopic surgery: This type of surgery is performed through small incisions in the skin and using an arthroscope or endoscope, a small instrument with a camera that allows the surgeon to see inside the joint and remove the cause of the pain. The method is less invasive than opening the external elbow, but is usually only used for milder cases.

During arthroscopic lateral epicondylectomy, the surgeon may do the following:

  • remove damaged tissue using special instruments to get rid of tissue in the elbow area that is causing pain
  • reconstruct tendons and muscles that are damaged or inflamed
  • remove bony growths that cause pain.

Elbow arthroscopy has several advantages over open surgery or other treatment procedures:

  • Minimally invasive: Arthroscopic elbow surgery requires only small incisions in the skin, which means less damage to the surrounding tissues and less pain after surgery.
  • Reduced risk of infections, bleeding and other complications associated with open surgery.
  • Faster recovery and return to normal activities.
  • Minimal scarring: Due to the tiny incisions, the scars after arthroscopic elbow surgery are smaller and hardly noticeable.
  • Increased precision because the arthroscope allows the surgeon to see better and more precisely treat the problem in the elbow joint thanks to the magnification.

To sum up, arthroscopic elbow surgery is usually performed using smaller skin incisions, resulting in a less traumatic procedure. This results in less pain, minimal scarring, and a shorter recovery period when compared to open surgery.

Arthroscopic tennis elbow surgery is done under general anesthesia, and patients can usually go home the same day. Recovery usually takes several weeks, and patients may need to wear a special brace to support the arm and elbow joint. Physiotherapy can be useful in strengthening the muscles and restoring movement of the hand and forearm after surgery. It is important to note that arthroscopic tennis elbow surgery is usually not the first line of treatment and is performed only after all other treatment options have been exhausted.