Tennis/Golfer's Elbow
NHS Tayside RefGuide
Warning
Who to refer
- Surgery may be considered if symptoms persist for more than a year with failure to respond to physiotherapy and at least 2 steroid injections.
Who not to refer
- Patients who have not had conservative treatment tried (Physiotherapy and at least 2 steroid injections.
How to refer
- If under the care of the TNHS MSK physiotherapy team, onward referral to UL service, if appropriate, will be organised by Physiotherapy service without the need for further GP intervention
- SCI gateway/ Orthopaedic - Elbow and shoulder.
Information to include when referring
- Duration of symptoms, dominance, effect on ADL, work, hobbies
- Indicate site/spread of pain and if constant or intermittent, and/or waking at night
- Include treatment to date (clasp/injections/ physiotherapy).
Symptoms and signs
Tennis
- Recurring pain on the lateral aspect elbow; occasionally, pain radiates down the arm toward the wrist.
- Localised tenderness extensor origin
- Increased pain on active and/or resisted wrist dorsiflexion
- Pain caused by lifting or bending the arm or grasping light objects.
Golfer's
- Recurring pain on the medial aspect elbow; occasionally, pain radiates down the arm toward the wrist.
- Localised tenderness flexor origin
- Increased pain on active and/or resisted wrist palmar flexion
- Pain caused by lifting or bending the arm or grasping light objects.
Both tennis/ golfer's elbow
- Difficulty extending or flexing the elbow fully
- Benign Self limiting conditions: Pain typically lasts for 6 – 12 months; the discomfort can continue for as little as 3 weeks or as long as several years. 90% people make a full recovery in a year.
- Women and men affected equally, peak incidence occurs between 35–54 years of age.
Initial management
- Advice / reassurance / occasional analgesia & NSAIDs / topical anti-inflammatory as appropriate
- Modify loading
- Eccentric loading exercises advocated- refer MSK Physiotherapy
- Symptomatic measures (steroid injection (CSI) for short term symptomatic relief. Can be given by MSK Physiotherapist.
- Epicondylar clasp can be bought from Boots/ Allardyce/PhysioMed/online.