Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Lateral Epicondylitis ( Tennis Elbow )

SYMPTOMS

There is gradual onset of exercise induced pain around the lateral epicondyle of the elbow aggravated by hyper-flexion and supination of the wrist.

AETIOLOGY

This is an over-use type injury of unknown aetiology, affecting the wrist extensor muscle origin at the lateral epicondyle in racket sports players, javelin throwers and cricket bowlers. Despite the name, tennis players are an absolute minority of patients. And in further contrast with its name, there is no local inflammation.

CLINICAL FINDINGS

There is tenderness on palpation over the lateral epicondyle and pain and weakness on a resisted Waiter test.

INVESTIGATIONS

X-ray and MRI are normal.

TREATMENT

Temporary partial immobilisation may relieve symptoms. Address bowling technique, errors in racket grip or throwing, etc. Recommend
double backhand in tennis. Cortisone injections may be considered. A soft neoprene brace may decrease symptoms.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon if this diagnosis is suspected or if the diagnosis is not clear. Only in persistent cases or when symptoms are severe is surgery (Homan’s operation) needed.

EXERCISE PRESCRIPTION

Many sports can be maintained. Running, cycling and swimming are good alternatives to keep up general fitness. Gym training can be maintained.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and good elbow function. Compare with other elbow.

DIFFERENTIAL DIAGNOSES

Loose bodies, OCD, synovitis (MRI can differentiate). Referred pain from the cervical spine (examine the neck).

PROGNOSIS

Excellent, if treated appropriately.

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