Introduction 

Tennis elbow is a condition that causes pain around the outside of the elbow.

It's clinically known as lateral epicondylitis.

It often occurs after strenuous overuse of the muscles and tendons of the forearm, near the elbow joint.

You may notice pain:



on the outside of your upper forearm, just below the bend of your elbow



when lifting or bending your arm



when gripping small objects, such as a pen



when twisting your forearm, such as turning a door handle or opening a jar



You may also find it difficult to fully extend your arm.

 

What causes tennis elbow?

The elbow joint is surrounded by muscles that move your elbow, wrist and fingers. The tendons in your elbow join the bones and muscles together, and control the muscles of your forearm.

Tennis elbow is usually caused by overusing the muscles attached to your elbow and used to straighten your wrist. If the muscles and tendons are strained, tiny tears and inflammation can develop near the bony lump (the lateral epicondyle) on the outside of your elbow.

As the name suggests, tennis elbow is sometimes caused by playing tennis. However, it is often caused by other activities that place repeated stress on the elbow joint, such as decorating or playing the violin.

Pain that occurs on the inner side of the elbow is often known as golfer's elbow.

 

When to see your GP

If your elbow pain is caused by a strenuous or repetitive activity, you should avoid the activity until your symptoms improve. 

Visit your GP if the pain in your elbow persists, despite resting it for a few days. They will check for swelling and tenderness, and carry out some simple tests, such as asking you to extend your fingers and flex your wrist with your elbow extended.

Further tests, such as an ultrasound scan or a magnetic resonance imaging (MRI) scan will only be needed if it is thought that your pain is being caused by nerve damage.

 

Treating tennis elbow

Tennis elbow is a self-limiting condition, which means it will eventually get better without treatment.

However, there are treatments that can be used to improve your symptoms and speed up your recovery.

It's important that you rest your injured arm and stop doing the activity that's causing the problem.

Holding a cold compress, such as a bag of frozen peas wrapped in a towel, against your elbow for a few minutes several times a day can help ease the pain.

Taking painkillers, such as paracetamol, may help reduce mild pain caused by tennis elbow. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also be used to help reduce inflammation.

Physiotherapy may be recommended in more severe and persistent cases. Massaging and manipulating the affected area may help relieve the pain and stiffness, and improve the range of movement in your arm.

Surgery may be used as a last resort to remove the damaged part of the tendon.

Most cases of tennis elbow last between six months and two years. However, in about nine out of 10 cases, a full recovery is made within a year.

 

Preventing tennis elbow

It's not always easy to avoid getting tennis elbow, although not putting too much stress on the muscles and tendons surrounding your elbow will help prevent the condition getting worse.

If your tennis elbow is caused by an activity that involves placing repeated strain on your elbow joint, such as tennis, changing your technique may alleviate the problem.



Tennis elbow is pain on the outside of the elbow 

 


Who is affected by tennis elbow?

Tennis elbow is a common musculoskeletal condition. It's estimated that as many as one in three people have tennis elbow at any given time.

Each year in the UK, about five in every 1,000 people go to see their GP about tennis elbow.

The condition usually affects adults and is more common in people who are 40-60 years of age. Men and women are equally affected.






Sports injuries

Symptoms of tennis elbow 

Tennis elbow causes pain and tenderness on the outside of your elbow. You may also have pain in your forearm and in the back of your hand.

The pain of tennis elbow can range from mild discomfort while using your elbow, to severe pain that can be felt when your elbow is still.

The pain is often worse when you use your arm, particularly for twisting movements. Repetitive wrist movements, such as extending your wrist and gripping, can also make the pain worse.

If you have tennis elbow, you will usually experience:



pain on the outside of your upper forearm, just below your elbow – the pain may also travel down your forearm towards your wrist 



pain when lifting or bending your arm



pain when writing or gripping small objects – for example, when holding a pen



pain when twisting your forearm – for example, when turning a door handle or opening a jar



pain and stiffness when fully extending your arm



An episode of tennis elbow will usually last between six months and two years. However, the majority of people (90%) will make a full recovery within a year.

 

Causes of tennis elbow 

Tennis elbow is often an overuse injury. It occurs when the muscles and tendons in your forearm are strained due to a repetitive or strenuous activity.

Tennis elbow can also sometimes occur after banging or knocking your elbow.

If the muscles and tendons in your forearm are strained, tiny tears and inflammation can develop near the bony lump (lateral epicondyle) on the outside of your elbow.

You may get tennis elbow if your forearm muscles are not used to doing a certain activity, such as gardening or decorating. However, even if you use your forearm muscles frequently, you can still injure them.

Activities that can cause tennis elbow

You can develop tennis elbow by doing any form of activity that involves repeatedly twisting your wrist and using your forearm muscles. Examples include:



playing racquet sports – such as tennis, badminton or squash (see below)



throwing sports – such as the javelin or discus 



using shears while gardening



using a paintbrush or roller while decorating



manual work – such as plumbing or bricklaying



activities that involve fine, repetitive hand and wrist movements – such as using scissors or typing 



other activities that involve repeatedly bending the elbow – such as playing the violin



Playing racquet sports increases your risk of developing tennis elbow, particularly if you play for the first time in a long time. However, despite its name, only five out of 100 people actually get tennis elbow from playing racquet sports.

 

Treating tennis elbow 

Tennis elbow is a self-limiting condition, which means it will eventually get better without treatment.

However, it can often last for several weeks or months, because tendons heal slowly. In some cases, tennis elbow can persist for more than a year.

A number of simple treatments can help alleviate the pain of tennis elbow. The most important thing you can do is rest your injured arm and stop doing the activity that caused the problem (see below).

Holding a cold compress, such as a bag of frozen peas wrapped in a towel, against your elbow for a few minutes several times a day can help ease the pain.

Invasive treatments, such as surgery, will usually only be considered in severe and persistent cases of tennis elbow, where non-surgical approaches have not been effective.

Read on to learn about the different treatments you may be offered. You can also see a summary of the pros and cons of these treatments, which allows you to easily compare your options.

 

Avoiding or modifying activities

If you have tennis elbow, you should stop doing activities that strain affected muscles and tendons.

If you use your arms at work to carry out manual tasks, such as lifting, you may need to avoid these activities until the pain in your arm improves.

Alternatively, you may be able to modify the way you perform these types of movements so they do not place strain on your arm.

Talk to your employer about avoiding or modifying activities that could aggravate your arm and make the pain worse. 

 

Painkillers and NSAIDs

Taking painkillers, such as paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help ease mild pain and inflammation caused by tennis elbow.

As well as tablets, NSAIDs are also available as creams and gels (topical NSAIDs). They are applied directly to a specific area of your body, such as your elbow and forearm.

Topical NSAIDs are often recommended for musculoskeletal conditions, such as tennis elbow, rather than anti-inflammatory tablets. This is because they can reduce inflammation and pain without causing side effects, such as nausea and diarrhoea.

Some NSAIDs are available over the counter without a prescription, while others are only available on prescription. Your GP or pharmacist will be able to recommend a suitable NSAID.  

 

Physiotherapy

Your GP may refer you to a physiotherapist if your tennis elbow is causing more severe or persistent pain. Physiotherapists are healthcare professionals who use a variety of methods to restore movement to injured areas of the body.

Your physiotherapist may use manual therapy techniques, such as massage and manipulation, to relieve pain and stiffness, and encourage blood flow to your arm. They can also show you exercises you can do to keep your arm mobile and strengthen your forearm muscles. 

The use of an orthoses – such as a brace, strapping, support bandage or splint – may also be recommended in the short term.


 Corticosteroid injections 

Corticosteroid injections are sometimes used to treat particularly painful musculoskeletal problems. However, there is limited clinical evidence to support their use as an effective treatment for tennis elbow.

Corticosteroids are a type of medication that contain man-made versions of the hormone cortisol.

Corticosteroid injections may help reduce the pain of tennis elbow in the short term, but their long-term effectiveness has been shown to be poor.

The injection will be made directly into the painful area around your elbow. Before you have the injection, you may be given a local anaesthetic to numb the area to reduce the pain.  

Shock wave therapy

Shock wave therapy is a non-invasive treatment, where high-energy shock waves are passed through the skin to help relieve pain and promote movement in the affected area.

How many sessions you will need depends on the severity of your pain. You may have a local anaesthetic to reduce any pain or discomfort during the procedure.

The National Institute for Health and Care Excellence (NICE) states that shock wave therapy is safe, although it can cause minor side effects, including bruising and reddening of skin in the area being treated.

Research shows that shock wave therapy can help improve the pain of tennis elbow in some cases. However, it may not work in all cases, and further research is needed.

 

 Surgery 

Surgery may be recommended as a last resort treatment in cases where tennis elbow is causing severe and persistent pain. The damaged part of the tendon will be removed to relieve the painful symptoms.



Painkillers and anti-inflammatory medication may help reduce mild pain and inflammation caused by tennis elbow 





Compare your options

Take a look at a simple guide to the pros and cons of different treatments for tennis elbow

 

Preventing tennis elbow 

It is often difficult to prevent getting tennis elbow.

However, not putting strain on the tendons of your elbow will help you to avoid the condition or prevent your symptoms getting worse.

Self care advice

Listed below are some measures you can take to help prevent tennis elbow developing or recurring:



If you have tennis elbow, stop doing the activity that is causing pain, or find an alternative way of doing it that does not place stress on your tendons.



Avoid using your wrist and elbow more than the rest of your arm. Spread the load to the larger muscles of your shoulder and upper arm.



If you play a sport that involves repetitive movements, such as tennis or squash, getting some coaching advice to help improve your technique may help you avoid getting tennis elbow.



Before playing a sport that involves repetitive arm movements, warm up properly and gently stretch your arm muscles to help avoid injury.



Use lightweight tools or racquets and enlarge their grip size to help you avoid putting excess strain on your tendons.



Wear a tennis elbow splint when you are using your arm, and take it off while you are resting or sleeping to help prevent further damage to your tendons. Ask your GP or physiotherapist for advice about the best type of brace or splint to use.



Increasing the strength of your forearm muscles can help prevent tennis elbow. A physiotherapist can advise you about exercises to build up your forearm muscles.
 
Epicondylitis