Dr Dion Lewis
MBBS (hons) BMedSci (hons)
Case 1: A 41 year old bricklayer is referred via his GP with tennis elbow after failure to respond to treatment with a tennis elbow brace and corticosteroid injection. He initially improved following the injection, but after a few weeks his pain started to return. He had seen a physiotherapist when he first developed pain a few months prior who tried some soft tissue therapies which did not help. The Ultra Sound shows moderate tendinopathy in the common extensor origin with neovascularity but no evidence of tear. After initiation of a tendon loading program with a new physiotherapist and some basic modifications at work, he gradually improved over the next few months without the need for further injectable therapies.
Case 2: A 50 year old landscaper was referred with tennis elbow that had persisted for nearly 2 years. Despite a few periods of time off work, 3 corticosteroid injections and intensive rehabilitation with a good physiotherapist who had provided an appropriate tendon loading program, he was still experiencing difficulties. Ultra Sound and MRI showed high grade common extensor origin tendinopathy with an intrasubstance split tear. A surgeon had suggested he may benefit from operative management, but the patient was not keen to pursue surgery at this stage. Two platelet rich plasma injections were performed under Ultra Sound guidance directly into the intrasubstance tear whilst the patient continued his rehabilitation program. With careful guidance, 3 months later the patient was pain free.
Like all tendinopathies, tennis elbow can be difficult to treat. As knowledge surrounding the pathophysiology of tendinopathies has expanded, there is an increasing shift away from rest and corticosteroid injection to controlled tendon loading and activity modification. These days’ corticosteroid injections are generally utilised as a means of reducing pain to enable maintenance of an appropriate tendon loading program. Platelet rich plasma also has a role in selected patients, particularly those with more advanced tendinopathy, tendinopathy that has failed to respond to apparently adequate and appropriate rehabilitation or tendinopathy with intrasubstance tendon tears.