Tennis Elbow: Turn the Tables

Table tennis. Never say ping pong to these athletes- learnt that the hard way! Didn’t know much about this competition but watching it you need super fast reflexes for the 3 second rallies and a breeze free arena otherwise the 4g ball wobbles in the air. This means that the movie world studio had special air locks installed to stop crosswinds!

The most common injuries seen in Table Tennis are elbow lesions, lower back injury and knee injury so it’s a good time to talk about Tennis Elbow.

Commonwealth Games Gold Coast 2018

Tennis elbow is a very common injury in activities with repetitive movements of the forearm.  Also known as lateral epicondylitis or a “wrist extensor over use injury”.

The main way to cause tennis elbow is through repeated gripping or extending of the wrist over and over again during sporting activities.  Lots of racquet sports see athletes get this condition including squash, badminton,  table tennis…..and not surprisingly actual tennis.   Although tennis players only make up about 10% of the total number of patients who experience tennis elbow.  It can be usually put down to problems with technique, poorly fitted equipment, or inadequate muscle conditioning prior to intensive sporting activity.

A typical patient with tennis elbow will experience onset of pain over the outside of the elbow.  It is usually localised to one specific point that the player can locate with a single finger and it is often provoked when they grip their racquet for example.  Onset usually occurs over a period of weeks to months and can be associated with a change in equipment. Usually, the pain will improve when the player rests but intensifies again with activity.  Pain can be reproduced by holding the arm straight and extending the wrist backwards.  Review of your elbow by a doctor is needed to exclude a more serious neurological condition they would do this by also assessing for numbness and tingling in the hand or fingers.  Usually a tennis elbow can be confirmed without imaging but it may be important to make sure that there aren’t any other reasons for the pain such as osteoarthritis, bursitis or bone abnormalities.  Again your GP is in the best position to complete this assessment.

Commonwealth Games Gold Coast 2018

The good news is tennis elbow is often self limiting with symptoms often vanishing after 1-2 years by themselves.  Rest is the mainstay of treatment.  Ibuprofen and ice are useful for pain relief.  A recent review suggested topical Ibuprofen may improve pain but the science for this was of low quality and can’t be generalised to every patient, this is something best to be discussed with you GP.  Forearm stretching and strengthening by occupational therapists or physiotherapists can help with pain relief by focussing on stretching the common extensor tendon.

In certain patients where pain is ongoing and the condition is confirmed after extensive clinical examination a steroid injection may be considered by your doctor.  However its important to note that this may only give short term relief.  A recent analysis of several papers investigating steroid injections as a treatment for tennis elbow concluded that there was no difference in pain intensity when compared to placebo six months after treatment.  Platelet- rich-plasma injections have been shown to be effective in physiotherapy resistant cases Acupuncture has been trialled for this condition but currently there is not enough high quality evidence in the scientific literature to support its efficacy and more research is needed.    In rare cases surgery can be considered however this is not a typical treatment strategy for a majority of patients.

  • These are my Tennis Elbow GPearls on the GC
    • never call it ping pong
    • tennis hardly ever causes tennis elbow
    • resting the elbow can lead to a straight sets win


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