Tennis elbow, causes and treatments - Operation
What is a tennis elbow?
Strain in certain professions involving specific and repetitive rotating movements of the forearm (cleaner/mechanic/etc.), as well as frequent use of a computer mouse can cause chronic strain of the outside of the elbow.
Complaints and treatment
The complaints will have been lurking in the background for a while. Discomfort is mostly felt when resting, before and/or after using the joint. We distinguish between localised discomfort on the lateral side of the elbow, which may or may not be combined with radiating pain across the forearm to the upper side of the second and third finger. In the first case it concerns a problem with the attachment of the different extensions of the fingers and wrist, specifically at the outside of the elbow. This tendon inflammation usually displays a chronic component (tendinosis) with an intermittent or sudden acute onset (tendinitis). If there is radiating pain across the forearm, clamping the deep branch of the radial nerve (posterior interosseous nerve) at the supinator muscle and fascia should be considered. (Fig. 24) In some cases this problem occurs on its own with no tennis elbow! Tennis elbow and/or posterior interosseous nerve are diagnosed using X-ray and ultrasound. An NMR scan is also recommended in some cases. Tennis elbow is always treated conservatively at first. Localised anti-inflammatory treatment with NSAID gel and/or NSAID taken orally. Use of a type of brace (EpiPoint), supplemented if necessary with one to three localised infiltrations with corticoid.
In addition intensive physiotherapy begins, stretching the extensors. If, after a sufficiently long period, this conservative treatment fails, a surgical procedure can be considered. This is performed under loco-regional plexus anaesthetic (of the arm) in the outpatient clinic. In the procedure the traction (tension) in the attachment point is released and the attachment point is cleaned up so that new scar tissue can form without a continuous inflammatory reaction. At the same time the radial nerve can be released, if necessary. After surgery a relatively immobilising bandage lined with wadding is fitted, and worn for a period of two weeks. (A cast is fitted in exceptional cases). Rehabilitation can start after this has been done. The patient will be unfit for work for a period of two to three months. If only the radial nerve is released, rehabilitation begins right away with no period of immobilisation.