Letters, calls and emails: No need to refer when it comes to tennis elbow

Dear Editor

I felt compelled to write in relation to the article by Mr Mohan on the subject of elbow injuries in sport (GP, 6 October).

His comments about lateral epicondylitis (tennis elbow) demand an informed response.

He states that ‘it is commonly seen in recreational tennis players in the age group of 35 to 50 years’. I would love to know his source for this assertion. In 20 years of practice (many with a special interest in musculoskeletal medicine), I do not think I have ever seen such a case. Indeed evidence suggests that tennis is a factor in only about 5 per cent of cases.

His comments in relation to management also require correction. He suggests an injection after one week of failure to improve with conservative measures. In fact, steroid injections have now been shown to result in a worse long-term outcome, despite some short-term success. They should probably be avoided.

He writes: ‘If there is still no improvement the patient should be referred.’ One has to wonder which orthopaedic world Mr Mohan inhabits. Surgery is by no means always successful, and many orthopaedic surgeons are reluctant to operate. There is simply no substantial evidence that it works.

Eighty or 90 per cent of lateral epicondylitis cases resolve within a year with a conservative approach, and simple measures such as topical NSAIDs and a brace are probably the most useful and practical interventions.

GP commissioners take note.

Dr Denis J O’Brien

Liverpool

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