Overview

Tennis elbow
Tennis elbow

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 the elbow, which may travel down the forearm when:

  • lifting or bending your arm
  • gripping small objects, such as a pen
  • 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?

Tennis elbow is usually caused by overusing the muscles attached to your elbow and used to straighten your wrist. If the muscles 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, but any activity that puts repeated stress on the elbow joint can cause it.

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

When to see a GP

You should avoid the activity that is causing the pain until your symptoms improve.

If the pain in your elbow does not go away after a few days of rest, visit a GP.

The GP will check for swelling and tenderness, and carry out some simple tests, such as stretching out your fingers and flexing your wrist while your elbow is stretched out.

If the GP thinks the pain is due to nerve damage, further tests, such as an ultrasound scan or an MRI scan scan may be done.

Treating tennis elbow

Tennis elbow will get better without treatment (a self-limiting condition), but there are treatments that may improve your symptoms and speed up  recovery.

You should rest your injured arm and stop any 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. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also be used to help reduce inflammation.

Physiotherapy may be recommended in more severe 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.

Tennis elbow can last between 6 months to 2 years, but a full recovery is made within a year in 9 out of 10 cases.

Preventing tennis elbow

It'snot always easy to avoid getting tennis elbow, for instance if it was caused by something you do at work. Not putting too much stress on the muscles surrounding your elbow will help prevent the condition from getting worse.

If your tennis elbow is caused by a sport such as tennis or other activity that puts a repeated strain on your elbow joint, changing your technique may ease the problem.

Who's affected by tennis elbow?

Tennis elbow is a common condition that affects about 1-3% of the population (about 4 to 7 cases per 1000) every year.

It's the most common cause of persistent elbow pain, accounting for two-thirds of cases. It affects women and men equally, and those affected are mostly between the ages of 35-54.

Symptoms

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 the elbow, which may travel down the forearm 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 have pain and stiffness when fully extending your arm.

Tennis elbow usually lasts between 6 months and 2 years, with most people (90%) making a full recovery within a year.

Who can get it

Tennis elbow is mostly caused by overusing your forearm due to a repetitive or strenuous activity.

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

If the muscles 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, it can still happen.

Activities that can cause tennis elbow

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

  • playing racquet sports (tennis, badminton or squash) or sports that involve throwing (javelin or discus)
  • using hand tools repeatedly (gardening shears, screwdriver or scissors)
  • using tools while decorating, plumbing or bricklaying
  • activities that involve fine, repetitive hand and wrist movements (typing or sewing)
  • activities that involve repeatedly bending the elbow (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 5 out of 100 people actually get tennis elbow from playing racquet sports.

Treatment

Tennis elbow will get better without treatment (known as a self-limiting condition).

Tennis elbow usually lasts between 6 months and 2 years, with most people (90%) making a full recovery within a year.

The most important thing to do is to rest your injured arm and stop doing the activity that caused the problem.

There are also simple treatments to help with the pain, like 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.

Avoiding or changing activities

If you have tennis elbow, you should stop doing activities that strain the 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 change the way you do these types of movements so they do not place strain on your arm.

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

Painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)

Taking painkillers, such as paracetamol, and NSAIDs, such as ibuprofen, may help ease mild pain and inflammation caused by tennis elbow.

NSAIDs are available as tablets or creams and gels (topical NSAIDs) which are applied directly to the area of your body where there is pain.

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 feeling sick (nausea) and diarrhoea.

Some NSAIDs are only available with a prescription. A GP or pharmacist will be able to recommend a suitable NSAID. 

Physiotherapy for tennis elbow

The 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 will also be able to show you exercises you can do to keep your arm mobile and strengthen your forearm muscles.

The use of  a brace, strapping, support bandage or splint (called an orthosis) may also be recommended in the short term.

Read more about physiotherapy.

Steroid injections for tennis elbow

Steroids, medicines that contains synthetic versions of the hormone cortisol, are sometimes used to treat tennis elbow.

Some people with tennis elbow are offered steroid injections when other treatments have not worked.

The injection will be given directly into the painful area around the elbow. A local anaesthetic may be given first to numb the area and reduce the pain.

Steroid injections are only likely to give short-term relief and their long-term effectiveness is poor. If they're helping, you may be offered up to 3 injections in the same area, with at least a 3 to 6 month gap between them.

Shockwave therapy for tennis elbow

Shockwave therapy is a non-invasive treatment where high-energy shockwaves are passed through the skin to help relieve pain and promote movement in the affected area.

The number of 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.

Shockwave therapy, while safe, can cause minor side effects including bruising and reddening of skin in the area being treated.

Research shows that shockwave 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.

PRP injections for tennis elbow

Platelet rich plasma (PRP) is a treatment that may be offered by a surgeon in hospital to treat tennis elbow.

PRP is blood plasma containing concentrated platelets that your body uses to repair damaged tissue. Injections of PRP have been shown to speed up the healing process in some people but their long-term effectiveness is not yet known.

The surgeon will take a blood sample from you and place it in a machine. This separates the healing platelets so they can be taken from the blood sample and injected into the affected joints. The procedure usually takes about 30 minutes.

Surgery for tennis elbow

Surgery may be recommended 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.

Prevention

Preventing tennis elbow can be difficult.

Not putting a strain on the muscles in your forearm will help you to avoid the condition or stop your symptoms from getting worse.

Self care advice

The measures you can take that may stop tennis elbow from developing or coming back include to:

  • stop the activity that is causing pain, or find another way of doing it that does not cause pain or stress
  • avoid using your wrist and elbow more than the rest of your arm. It may also help to spread the load to the larger muscles of your shoulder
  • get coaching advice to help you change or improve your technique if you play a sport that involves repetitive movements, such as tennis or squash
  • warm up properly and gently stretch your arm muscles before playing a sport that involves repetitive arm movements
  • use lightweight tools or racquets and make their grip size bigger, to avoid putting extra strain on your tendons
  • wear a tennis elbow splint when you're using your arm (not while resting or sleeping) to stop further damage to your tendons. Ask a GP or physiotherapist for advice about the best type of brace or splint to use
  • increase the strength of your forearm muscles (a physiotherapist can advise you about exercises to build up your forearm muscles)


The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 21/09/2021 13:30:53