A tennis elbow is a tendinopathy at the outer aspect of the elbow, also known as a lateral epicondylitis.

There are many causes of the injury, one of which is reported to be excessive loading of the tendons playing a backhand stroke in tennis. More typically, the injury occurs on initiating heavy exercise (for instance, in the gym) as well as carrying heavy weights, such as suitcases, or overuse at work (for example, when using heavy, vibrating machinery).

This case involved a middle-aged gentleman who worked for a construction company. After six to nine months, he began to develop pain in the outer aspect of both elbows. He went to see his GP and was diagnosed as having bilateral tennis elbows. This calmed down when he stopped work for six weeks following a steroid injection into both elbows.

He resumed the same occupation, and between four and six months later, the condition recurred. He was off work for a further three months following repeat injections, and his employment was terminated shortly thereafter.

A review of his work history indicated his job involved heavy drilling into concrete at least two to three days a week, and also using a jackhammer. He regularly worked overtime at weekends and used percussive tools, such as a grinder and a mini breaker. He estimated that during a typical shift, there would be three to three-and-a-half hours’ trigger time. He was provided with personal protective equipment, such as ear plugs, safety boots, knee pads and a hard hat. He was given gloves, but these were not anti-vibration gloves.

The medical diagnosis of lateral epicondylitis (tennis elbow) was confirmed from historical notes and records. When he was seen for a medico legal report some two years after he stopped his employment, there was still some tenderness in the outer aspect of the right elbow, but not the left.

A consulting engineer was able to identify the tools that were being used at the time, and obtained vibration magnitude values for these from the manufacturer’s literature.  These compared well with the 1994 Hand Arm Vibration guidance from the Health and Safety Executive, and also the 2005 Control of Vibration at Work Regulations. He could, therefore, calculate the equivalent action value that this gentleman was subjected to, and also show that it exceeded the equivalent limit value.

The action succeeded – and this case demonstrates how two experts working in different fields can complement each other’s reports to determine liability and causation. Neither would be successful on their own to reach an accurate analysis for legal purposes. In this instance, the medical expert confirmed the medical diagnosis of tennis elbow, and the engineer determined whether the ergonomics of the work practice were likely to be unsafe.

MDU figures for 2022 show that fewer than one in six actions in medical negligence actually succeed, with the vast majority failing on the grounds of causation. It must be remembered that subsequence is not the same as consequence.

Initial screening is, therefore, essential to manage client expectations at an early stage. This avoids unnecessary effort and costs for all concerned. Too many cases are taken to court with no chance of success. This is stressful for both the client and their legal adviser, and indeed for the medical personnel involved.

For fast and effective screening of all potential medical negligence cases, contact Peyton Medico Legal Services now on +44 (0)28 87724177, or email [email protected]