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Tennis elbow and Golfer’s elbow


Referrals for USS guided steroid injections to RCHT Clinical Imaging have restarted.  Please note there is limited capacity so referrals should be reserved for patients with significant disabling and persistent symptoms.  Please click here for full details



Covid-19 Update: Corticosteroid Injections During The Coronavirus Pandemic 

Please note that any patients considering steroid injections during the Coronavirus pandemic require a risk assessment and counselling on increased risks with Covid prior to performing.  Secondary care referrals for steroid injection, including image guided injections, require the patient to be counselled and risk assessed prior to referral and this documented in the referral.  Please see guidance available here for detailed information.




Both conditions are self-limiting with an average duration of between 6 months to two years

For more than 90% of patients, non-surgical measures are successful

Differential Diagnoses

  • Referred pain from the cervical spine
  • Referred pain from shoulder or wrist injuries
  • Osteoarthritis
  • Radial tunnel syndrome (compression of the posterior interosseous nerve).

Primary care management:

  • Rest the arm and reduce aggravating activities(whilst maintaining normal activity where possible) for 6 weeks
  • Physiotherapy
  • Appropriate tailored analgesia
  • Steroid injection        May be helpful for short term relief of severe pain, however unlikely to affect long term outcome and relapses are common, not routinely recommended
  • Orthoses such as forearm bands can be helpful especially with functional impairment

 

Acupuncture is not recommended

 

Referral Criteria

  • The diagnosis is uncertain.
  • Pain or functional limitation is severe.
  • Functional disability and pain persist after 6–12 months of non-surgical management.



References

National Institute Of Clinical Excellence.  Tennis Elbow.  Clinical Knowledge Summaries, April 2015

Bisset, L., Coombes, B and Vicenzino, B. Tennis elbow.Clinical Evidence BMJ Publishing; 2011

Bisset, L., Beller, E., Jull, G. et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial.  British Medical Journal; 2006 333(7575), 939

 

Date reviewed                     11/03/2022

Next review due                  11/03/2023

Sifter name                          Dr Rebecca Hopkins

 

Version No. 1.2