What is tennis elbow?
It is a disease that causes pain on the outer part of the elbow when using the same side hand. With repeated strong hand use, pain occurs in daily life activities due to structural deterioration in the tendons at the attachment point of the muscles that lift the wrist and fingers upwards or in the immediate vicinity of this area and healing problems. It is more common in professionals who frequently use hand tools such as screwdrivers and pliers, and in housewives who do extensive housework.
How is the diagnosis made?
The diagnosis of tennis elbow is usually made by listening carefully to the complaints and physical examination. It can be placed with . In patients with short-term complaints, the pain is around the bone protrusion on the outside of the elbow. (Picture 1) Initially, there is pain only when using the hand. Complaints of pain occur during tasks such as not being able to carry a shopping bag, pain when lifting an object from the table, opening tight lids, or peeling and chopping. However, as the duration of the complaints increases and the damage grows, pain may be felt during rest. This pain, which is felt most around the elbow, can sometimes be reflected in the upper part of the arm and forearm, all the way to the hand. Pain that wakes you up at night is rare, but it is a complaint that may be encountered in advanced cases. In addition to these clinical complaints, the diagnosis can be made on physical examination when there is tenderness in and around the common attachment point of the muscles that lift the fingers and wrist up on the elbow, and pain occurs in the same area when the wrist and fingers are lifted up against resistance.
The diagnosis can be made in the area in question. In cases of small palpable hardness or significant swelling, bone-like structures can be seen in the area corresponding to this area on plain radiographs. Generally, in cases where the complaints are not very long and typical findings are detected, another examination or examination is performed. Treatment can be started without any need for treatment. In cases with a significant history of injury or strain and in cases where interventional treatments are planned, elbow magnetic resonance examination can be used for diagnosis and treatment plan.
How is it treated?
How long the complaints have been present will determine the treatment method. and plays an important role in its success. In cases of complaints lasting less than three or four weeks, it is generally beneficial not to use the hand excessively in tasks that cause pain, to apply painkillers and anti-inflammatory gels or creams to the painful area, to apply cold to the area, massage, gentle stretching movements, physiotherapy tape applications and to use oral painkillers and/or anti-inflammatories. It is important to keep in mind that this treatment will not be shorter than 2 weeks and to know that stopping it too short and returning to normal activity will cause the complaints to come back more severe and more resistant. If the complaints have been present for a longer period of time, such as three or four months, a similar treatment is started. The treatment period may be 3-4 weeks. If the desired improvement cannot be achieved in the first two weeks, local anesthetic drugs can be applied to the area with a needle to accelerate the slowed healing, causing bleeding in the bone and accelerating the healing events. In cases of longer-term complaints, steroids (cortisone drugs) can be injected into the area to enable effective stretching exercises and painless rehabilitation. In those with long-term complaints, an attempt can be made to accelerate healing by using sound waves. Regional injection treatments can be used in patients who do not respond sufficiently to simple treatments to both reduce pain and accelerate recovery. Only local anesthetic can be used to create bleeding, steroid injection and recently PRP injection can be used. are methods. Steroid injection should not be repeated at short intervals, less than 3 months. In addition to these treatments, there are also treatments that attempt to reduce pain complaints by using different devices. There is no valid evidence that any type of these devices is better than the other, nor is there any evidence that permanent benefits are obtained with long-term use, except for short-term use in extremely painful situations. In this case, the devices are useful when used for short periods of time in very painful patients, if they are of a type that allows the fingers and wrist to rest.
Is surgery necessary?
It has been applied for more than six months. In cases where there is no adequate response to massage, stretching, oral and/or regional anti-inflammatories and injection treatments, the deterioration in the relevant area can be cleaned with surgical methods and a more appropriate recovery can be achieved. Cleaning procedures can be performed through open or closed (arthroscopic) surgeries. After cleaning procedures performed with closed surgery, the recovery period and the number of painful days after surgery are shorter.
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