Current Evidence in Tennis Elbow

Lunchtime Lecture 14th May 2012 by Dr Tim Wood, Sports Physician, Glenferrie Private Hospital, Hawthorn, Melbourne 3122  held at Albert Street Sports and Spinal Injuries Centre, Warragul

Topics discussed:

Why does tendinopathy occur?
Overload.  Trauma such as a sudden blow to the elbow (inflammatory in acute stages) - NSAIDs may be beneficial here.  Rest rarely cures the problem - we need to load the tendon at a level that it can cope with and challenge it from there.

Pathophysiology of tendinopathies - healthy tendon comprises of tight collagen fibres, tenosites and protein ?ground substance.  When the collagen breaks down, ground substance infiltrates the spaces and allows for neovessels to become embedded.  It is still uncertain what causes the pain associated with tennis elbow but perhaps the nociceptive neovessels could be responsible.  The increase in ground substance can lead to partial tears in the tendon.  Both ground substance build up and neovessels can be shown up on ultrasound, both musculoskeletal and Doppler.

Cortisone, Autologous Blood Injection, Platelet Injection & Surgery - what works well?
Less use of cortisone in sub-acute to chronic stages, unless pain is constant and severe as CSI can be an effective pain reliever.  Autologous Blook Injections are now performed in-rooms in Melbourne and also under ultrasound guide.  Platelet injection is expensive and used less regularly but provided 8-9x greater effect of blood injection than the ABI.  Surgery is now less common due to poor results.  The only surgeon in Melbourne still to perform this type of surgery is Greg Hoy at the Melbourne Orthopaedic Group.

Rehabilitation protocol:
Broomstick exercise 3x15 reps daily
Find the centre where weight is eveny distributed.  Start at that level with supination and pronation exercises and as pain allows, gradually moved hand down towards the top of the handle, 1cm by 1cm over a 12 week period.