Epicondylitis (tennis or golfer's elbow)

Epicondylitis is characterized by a chronic inflammation of the tendon attachments at the outer or inner epicondylus of the elbow. Mostly there is also degeneration (natural ageing) making treatment difficult. Not only tennis players or golfers are affected as the name might suggest, but people performing a lot of work using their hands, whether in their private or professional lives. In particular people with a computer workplace who often use the mouse have this pain, but also patients carrying out heavy work or repeated movements such as the driving of screws or similar work.

Conservative treatment

If epicondylitis is treated at an early stage, it is generally possible to ease the pain quickly.
Local measures such as friction massages, iontophoresis, and careful stretching and toning up of the muscles affected after easing the pain will lead to improvement. During this phase, rest is important. In addition, as a prophylactic measure, the workplace may be equipped with supporting tools. This includes mouse pads with a small gel cushion and gel bars at the keyboard resulting in relief for the overstrained finger and wrist extensor muscles.
In case of constant strain, wearing an epicondylitis bandage is useful.
Injections with a local anesthetic with corticoid added should only be administered in case of acute and heavy pain and only temporarily since the cortisone may damage the tendon tissue in the long term.
Immobilizations using a cast are unpopular with the modern patients and are certainly not compatible with our challenging work and recreation environment.

Surgical treatment

Objective

If all above mentioned measures cannot eliminate the complaints even after 6 months, surgery is indicated. The objective is to restore a painless function of the muscles affected.

Technique

According to our preferred technique according to Nirschl, the pathologically altered part of the tendon of the Musculus extensor carpi radialis brevis (ECRB) is removed and several holes are drilled into the bone in the epicondylus area so that blood may emerge. After suturing the tendon attachments, the cells and substances contained in the blood foster the healing of the tissue on the epicondylus. This intervention is performed in an open technique using a skin cut of about 4 cm.

Fig. 67: Intraoperative image after removal of the pathologic tissue and microfracturing of the bone.

Follow-up treatment

First, the elbow is immobilized in a splint for a week. Afterwards, careful follow-up treatment begins under guidance of a physiotherapist according to a regime we developed.
After about 8 weeks, the patient's professional activity should be painlessly possible, but sport should be done only after 3 months at the earliest. According to our experience, follow-up treatment of a golfer's elbow takes slightly longer. Experience and results show that 95% of the patients are satisfied with this kind of proceeding.