Rest is the treatment of choice when the pain first appears. If the pain is severe, short term immobilisation of the arm in a splint may be helpful in some patients.  This rest aims to allow the tiny tears in the tendon attachment to heal. Non-specific symptomatic treatments that can be used include non-steroidal anti-inflammatory drugs (NSAIDs),heat or ice. A counter-force brace or “tennis elbow strap” to reduce strain at the elbow  can help to limit pain and to protect against further damage. Physiotherapy, including a program of stretching, strengthening and local tissue massage may also provide some benefit.

What other treatments can be used?

A number of other treatment options are available supported by variable degrees of clinical evidence:

• Acupuncture.
• Injection of autologous blood or platelet-rich plasma.
• Extra-corporeal shock wave therapy (ESWT).
• Heat therapy.
• Local injection of cortisone and a local anaesthetic.
• Pulsed ultrasound to break up scar tissue, promote healing, and increase blood flow in the area.
• Sclerotherapy .
• Trigger point therapy.

Surgery?

In cases which fail to resolve with other treatment modalities surgery may be indicated. Many techniques have been described. Most  aim to release the strain on the affected muscle origin, remove degenerative tissue and promote healing.

Can these conditions be prevented or a recurrence avoided?

The use of appropriate coaching techniques, training regimes and equipment may be of use in reducing the risk of the condition occuring and minimising the risk of recurrence.

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What is it?

Elbow arthroscopy or keyhole surgery of the elbow involves the insertion of a small camera and instruments into the elbow joint through a number of small incisions (<1cm). The elbow is distended with fluid to allow the surgeon to visualise the inside of the joint and treat a variety of different conditions.

What conditions can it be used for?

Elbow arthroscopy can be used to treat a number of different conditions including osteoarthritis and rheumatoid arthritis. It can be used to remove loose fragments from the elbow or remove inflamed joint lining (synovitis) and can increase the range of movement of a stiff elbow joint. Cartilage damage to the joint surfaces (Osteochondritis dessicans) can also be repaired or removed.

Front of the elbow -Radial Head (Previous fracture)

Back of elbow – olecranon

What are the risks?

The main risks of elbow arthroscopy include damage to nerves and blood vessels. This can be reduced by careful placement of the incisions. Nerve injury is reported in approximately 4% of cases but usually resolves within the first 6 months after surgery. There is a small risk of infection, wound leakage (6%) and stiffness following surgery.

What are the results of surgery?

When used to try and increase the range of movement of a stiff elbow studies have shown that 90% of patients can get an increase in their range of movement. Results are best where the reduction in range has not been longstanding. When used to treat arthritis good or excellent results are obtained in around 85% of cases.

Front of the elbow – Establishing a lateral portal

Front of the elbow – Arthroscopic debridement

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