Tennis elbow

Also known as lateral epicondylitis

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

The medical name for tennis elbow is lateral epicondylitis because the pain is felt around the part of the humerus bone called the lateral epicondyle.

Key points

  1. Tennis elbow is commonly triggered by overuse of the muscles and tendons of the forearm, near the elbow joint.
  2. Resting the arm and avoiding doing things that make it worse is the key to recovery.
  3. Pain from tennis elbow usually lasts for 6 to 12 weeks, but can vary.
  4. It's  likely to settle quicker if you can avoid any activities that bring on symptoms.

Causes

Many people who get tennis elbow work or play sport that involves moving their arm in a repetitive way. Examples include activities that involve:

  • Fine, repetitive hand and wrist movements, such as using scissors or typing.
  • Repeatedly bending the elbow, such as playing the violin, cutting with a knife or using a paintbrush.
  • Twisting movements such as wringing clothes or using a screwdriver.
  • Playing racquet sports, such as tennis, badminton or squash.
  • Throwing sports, such as the javelin or discus.

Despite being called tennis elbow, racquet sports like tennis are only thought to be the cause in about 5 in 100 cases.

Injuries that lead to tennis elbow are usually caused by overuse of the forearm muscles in repeated actions. Tennis elbow can also occur:

  • After a knock or a bang to the elbow.
  • If you suddenly do a lot of something you’re not used to, for example, lots of gardening or playing tennis while on holiday.

Symptoms

Tennis elbow usually affects your dominant arm, ie, the arm that you write with. The main symptom of tennis elbow is pain on the outside of the upper forearm just below the bend of your elbow. You may also:

  • experience pain travelling from the outside of the elbow towards the wrist when twisting your forearm, for example when opening a jar
  • have pain when lifting, bending or extending your arm
  • find it difficult to grip items like pens
  • notice a stiffness in the affected arm.

Given rest and time, tennis elbow will get better on its own. A full recovery is made in most cases within a year. However, in 1 out of 10 cases, symptoms may last for up to 2 years.

Diagnosis

Visit your doctor if pain continues after the affected elbow has been rested for a few days. Your doctor will examine you for:

  • pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow
  • pain near the elbow when the wrist is bent backwards.

Further tests, such as ultrasound or MRIs (magnetic resonance imaging) will only be required if it is thought your pain is due to nerve damage.

Treatment

Treatment for tennis elbow aims to reduce elbow pain, help tissue repair and restore normal joint motion and function. Rest is the most important, and in many cases only, treatment required for tennis elbow. Other self care measures include applying ice and using an arm brace. If pain persists talk to your doctor or physiotherapist. Other treatments including medication, physiotherapy and surgery are available. 

Self care

Tendons take time to heal. Avoid the activity that causes the symptoms for at least 2 to 3 weeks. This will help to reduce inflammation so that the tendon injury can heal.

Try applying an ice pack, like a packet of frozen peas wrapped in a towel, to the sore area of your elbow for 10 minutes, 2 to 3 times a day.

You can protect and support your elbow with a special brace that wraps around the upper part of your forearm and takes some of the pressure off the muscles. Another option may be to wear a wrist splint to ease pain by helping to rest the muscles that pull on your elbow. Ask your GP or physiotherapist for advice about the best type of brace or splint for you to use.

Medication

Anti-inflammatory medications, such as ibuprofen. Some anti-inflammatories are available as a cream or gel that can be rubbed directly over the painful area. If you cannot take anti-inflammatory painkillers, other painkillers such as paracetamol may be helpful.

Corticosteroids may be injected around the area where the tendon attaches to the bone to help decrease the swelling and pain. Steroid injections may help ease pain in the short term but pain tends to come back in many people.

Physiotherapy

Physiotherapy and or strengthening exercises may not provide immediate pain relief but can help reduce pain recurrence in the long term. A physiotherapist can show you exercises to stretch and strengthen the muscles of your forearm. They may also use techniques such as massage, ultrasound or laser therapy.

Surgery

Surgery is considered as a last resort when severe pain continues after 6 to 12 months of rest and treatment. An orthopedic surgeon will be able to let you know whether surgery might help and what risks are involved. Most people who have surgery have full use of their elbow and forearm afterwards.

Prevention

It can be difficult to avoid getting tennis elbow and many people find it hard to stop doing the activities that cause it and rest. The measures below may help you prevent tennis elbow developing or recurring.

In general:

  • Avoid doing the activity that is causing pain or find a way of doing it that does not place stress on your tendons.
  • Spread the load to the larger muscles of the arm and shoulder; avoid using your wrist and elbow more than the rest of your arm.
  • Slowly increase your forearm strength and ease your way gently back into any twisting activities.

If your tennis elbow is due to a repetitive sports activity:

  • Consider getting some coaching advice to help improve or modify your technique.
  • Warm up properly and gently stretch your arm muscles to help avoid injury before playing.
  • Use lightweight equipment and enlarge their grip size to decrease the strain on your tendons.

If your symptoms are work related:

  • Discuss your options with your employer; there may be other tasks you could do while your elbow is resting or there may be changes that could be made to the way you work that could reduce the risk of it reoccurring.
  • Take regular breaks when you are working.

Learn more

Tennis elbow – what is it, treatments, and more Best Health, BMJ Publishing Group Limited, UK, 2013
Tennis elbow – condition leaflet Patient Info, UK
What treatments work for tennis elbow? Best Health, BMJ Publishing Group Limited, UK, 2013
Repetitive stress injuries TeensHealth from The Nemours Foundation, 2015
Decision aid for tennis elbow Patient Info, UK, 2013 

Credits: Health Navigator.