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Tennis or Golfer’s Elbow

Despite the names, tennis elbow and golfers elbow are usually a result of everyday activities. Although, we see a significant number of people that have elbow pain due to sporting activities.

You may experience pain in your forearm and in the back of your hand. Symptoms can range from a mild discomfort to severe pain that can be felt even when the joint is not active.

There is increasing evidence of PRP injections and its efficacy in treating these conditions. See our evidence page or make an an enquiry.

Mr. Ali Noorani: Compared to steroid injections, PRP therapy is a more effective treatment for tennis elbow.

Tennis and golfers elbow

Tennis elbow (lateral epicondylitis) occurs when the tendon which joins your forearm muscles to the outside of your elbow thickens and swells or develops small tears. It causes pain and tenderness.

It typically affects the dominant upper extremity and is associated with repetitive and forceful activity.  Pain is often most debilitating with wrist extension.

Golfer’s elbow (medial epicondylitis) causes pain and inflammation in the tendons which connect the forearm to the elbow. The pain revolves around a bony bump on the inside of your elbow and may radiate into the forearm.

Golfer’s elbow is often caused by overusing the muscles in the forearm that allow you to grip, rotate your arm, and flex your wrist.

To find out more watch Mr. Ali Noorani’s lecture on tennis elbow treatment.

Are you at risk?

Most people at risk of the injury tend to be office or manual workers and it is usually due to the overuse syndrome caused by repeated forceful wrist and finger movements resulting in excessive use of the forearm extensors (for tennis elbow) or the forearm flexors (for golfers elbow). Playing racket sports or golf does increase your risk, although the condition is often a result of prolonged rapid activities like playing the piano or typing.

We do know that smoking, high body mass index (BMI), certain medications, genetics and poor diabetic control play an important role in the presentation of lateral and medial epicondylar tendinopathy. 

  • 15% of people are likely to experience tennis or golfers elbow
  • men and women between the ages of 30 and 50 are more at risk
  • it can last for over two years and it can often reoccur

How do we diagnose tennis or golfers elbow?

Examination

Our experienced clinicians are able to diagnose tennis and golfers elbow by taking an accurate medical history (talking to the patient) and carrying out an examination. Patients who visit us for tennis elbow predominantly complain of pain on the outside of the elbow, while those with golfers elbow complain of pain on the inside of the elbow. These areas are often quite tender to touch on examination. There are certain tests that can confirm the diagnosis; for example gripping can be quite painful for the patient. Additionally, resistive extension of the wrist (Cozen’s test) as well as resistive extension of the middle finger (Maudsley’s test) can be quite symptomatic of tennis elbow.

Are X-rays required?

The use of X-rays and other imaging techniques like ultrasound and MRI scans are often not necessary to confirm the diagnosis however, they can be helpful in ruling out other conditions that can occur at the same time (e.g. ligament injuries). Imaging is also useful to confirm the extent of the injury to the tendons.

Discounting tendinosis

Tennis and golfers elbow are sometimes mistakenly referred to as lateral and medial epicondylitis, which is inaccurate, as this assumes inflammation in the area. Inflammatory conditions should be diagnosed as tendinosis. Tendinosis is when increased stress to the tendon from regular or recreational activities leads to a break down of the collagen within the tendons. This results in microscopic tears which if left untreated could develop into partial or full thickness tears. Therefore, both tennis and golfer’s elbow should be called lateral or medial epicondylar tendinopathy not lateral or medial epicondylitis.

Treatment of tennis and golfers elbow

Rest, medication and supports

​As tennis and golfers elbow are injuries to the tendons of the elbow, the treatment involves allowing this injury to heal naturally. In most cases, the purpose of the treatment is to control the pain and simultaneously improve grip strength and endurance, so patients can return to their normal activities. In order to do so, a temporary activity modification as well as anti-inflammatory pain killers (NSAIDs) can be enough to allow some relief during the healing process. Some patients also find it useful to use external support, such as tennis elbow clasps or taping to help reduce the symptoms.

Physiotherapy

Our clinicians strongly recommend that most patients do some form of physiotherapy. This can be self-directed (i.e. you do it yourself) or if the symptoms last for a few weeks it is best to seek out formal physiotherapy. There are some typical exercises that work to promote healing and improvement in symptoms for tennis and golfers elbow.

Pain-relieving Injections

Injections can help with symptoms of tennis/golfers elbow. Injections of local anaesthetic (or local anaesthetic patches) can temporarily help relieve the symptoms.

Steroid injections are not recommended as they have been used too often in the past and there is overwhelming evidence that suggest that they cause significantly more harm than good. In the short term, steroids can reduce the inflammation and pain, however, they don’t aid in the healing process and can further degenerate the tendon leading to long term complications and the prolongation of symptoms

Minimally-invasive regenerative treatments

The use of biologics including Platelet Rich Plasma (PRP) or Plasma Rich in Growth Factors (PRGF), are a very effective way of treating tennis elbow when physiotherapy and rehabilitation has failed.

PRP/PRGF concentrates growth factors from your blood and injecting them in the area affected by tennis or golfers elbow helps the healing process. There is overwhelming evidence, supported by randomised control trials, that proves PRP/PRFG is a more effective way of treating tennis and golfers elbow as opposed to the use of steroid injections.

At the Regenerative Clinic, patients often ask whether AMPP® (Activated Mesenchymal Pericyte Plasma) can be used to treat tennis and golfers elbow. The biologics of this treatment normally contains a small dose of PRGF, as well as adipose-based pericytes harvested with Lipogems®. Theoretically AMPP® is superior in regeneration and healing. You may have AMPP® in conjunction with the treatment of other joints, the results of which have been very positive.

Our Regenerative Clinic treatments effective in treating these conditions, include:

Surgery

If your symptoms have lasted for more than 6 weeks then it’s important for you to seek medical advice, in order to confirm diagnosis and ensure the treatment thus far has been appropriate. Surgery is almost never required for tennis elbow. It is often done to treat for other problems around the elbow, including ligament injuries which can sometimes mimic symptoms of tennis/golfers elbow.

PRP Therapy

Platelet Rich Plasma (PRP) therapy, also known as autologous conditioned plasma, takes advantage of the blood’s natural healing properties to repair damaged cartilage, tendons, ligaments, muscle and bone. It can reduce pain, improve joint function and helps you quickly return to normal activities. PRP supports your body’s self-healing processes by using your own cells. Blood is mostly liquid (called plasma) but also contains solid component including red cells, white cells and platelets. The platelets are important for clotting blood but they also contain proteins called growth factors which are important in the healing of injuries. With a higher concentration of growth factors than typically found in blood, PRP injections support the restoration of injured tissue and inhibit painful inflammatory processes. This treatment is widely researched and supported in clinical papers. See our PRP evidence section.

Find out more about tennis elbow

Watch Mr. Ali Noorani our upper limb surgeon discuss the benefits of using injections for treatment of tennis elbow.

“PRP has become an increasingly popular treatment option for professional athletes as well as those who have strained their outer elbow tendons”.

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