Tennis elbow

About tennis elbow

The medical term for tennis elbow is lateral epicondylitis or common extensor tendinopathy because it often affects the outside of your elbow bone, called the lateral epicondyle. This is the bony area you can feel on the outside of your elbow.

Tennis elbow may develop when the tendon that joins the muscles of your forearm to your upper arm (the humerus) becomes damaged and painful. The tendon is called the common extensor tendon (see diagram).

Tennis elbow is a common condition that affects between one and three in 100 people. Anybody can get tennis elbow but it's most common in people aged between 40 and 60. Depending on the severity, tennis elbow can last between six weeks and two years.

Tennis elbow is most often caused by repeatedly overusing the muscles in your arm or by minor injury. It often gets worse if you continue doing the activity that causes your pain.

Symptoms of tennis elbow

The most common symptom is pain and tenderness on the outside of your elbow and in the muscles of your forearm. Your symptoms will often develop gradually over time and your pain may become constant.

You may feel pain when you:

  • grip something, for example holding a pen or shaking someone's hand
  • twist your forearm, for example turning a door handle
  • use your keyboard or mouse
  • fully lengthen (extend) your arm

Many people with mild symptoms of tennis elbow find that their pain eases with rest and self-help treatments. However, if your symptoms don't improve after a couple of weeks, see your GP or physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) for advice.

If you have severe elbow pain, can't move your elbow joint or have any loss of feeling, you should seek urgent medical attention.

Causes of tennis elbow

Playing racquet sports, such as tennis or badminton, can cause tennis elbow. However, most people who get tennis elbow don't play tennis. The most common cause of tennis elbow is repeated overuse of your arm.

A range of different activities that involve repeated hand, wrist and forearm movements can also cause tennis elbow. Examples of these include:

  • using a screwdriver
  • sewing or knitting
  • using a keyboard and mouse
  • painting
  • gardening

You may also get tennis elbow if the muscles in your shoulder are weak, which places more stress on the muscles around your elbow and wrist.

Rarely, you can damage your tendon after a single and often minor incident, such as lifting something heavy or taking part in an activity that you don't do very often. These activities can cause small tears in your tendon.

Diagnosis of tennis elbow

You don't usually need to see your GP if you think you have tennis elbow. However, if your symptoms get worse and aren't helped by self-help measures and over-the-counter painkillers, see your GP or physiotherapist for advice.

Your GP or physiotherapist will ask you about your symptoms and examine you. He or she may also ask you about your medical history. He or she can usually diagnose tennis elbow from examining your arm and finding out how your symptoms developed. Further tests are rarely needed, however your GP or physiotherapist may recommend having an X-ray to rule out other conditions, such as arthritis, that can cause elbow pain.

If you have severe tennis elbow that hasn't got better with normal treatment, your GP or physiotherapist may recommend an ultrasound scan. An ultrasound scan uses sound waves to produce an image of the inside of your arm.

Treatment of tennis elbow

To make a full recovery, you will need to change the way you use your arm so that your tendon can rest and has time to heal. How you do this will depend on how you developed tennis elbow and how severe it is.

Self-help

You can treat your symptoms yourself if you have mild tennis elbow. Some of the main self-help treatments are described below.

  • Rest. The most important part of your treatment is to rest your injured tendon by stopping or changing the activity that is causing your pain.
  • Apply a cold compress to help ease your pain. You can apply a cold compress, such as an ice pack or ice wrapped in a towel as soon as you feel any pain. Hold this against your elbow for 10 minutes every two hours. Don't apply ice directly to your skin as it can damage your skin.
  • Wear a strap, splint or brace. You may want to try wearing a strap or brace around your forearm and elbow to help relieve the strain through your tendon. Some people may find this helps, but there is no evidence to show how well straps or splints work. You can buy arm braces and supports from some physiotherapists, pharmacies and sports shops. Don't wear a strap or splint continuously – you should leave it off at night. (See our common questions for more information)
  • Change the activity that caused the problem. If the problem has developed as a result of an activity at work, contact your employer's occupational health adviser, if available, or speak with your employer. They can give you advice on how to change the activity that caused the problem, allowing your arm to heal.

Medicines

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Non-steroidal anti-inflammatory painkillers (also known as NSAIDS), such as ibuprofen, are available as a cream or gel that you can put directly on your skin, or you can take them as a tablet.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Physical therapies

Your GP may refer you to a physiotherapist if he or she thinks physiotherapy will help to treat your tennis elbow. Your physiotherapist may try various techniques to reduce your pain. These may include exercises, deep tissue massage and acupuncture.

Your physiotherapist may give you a programme of exercises to do that stretches your muscles and that improves the movement and strength of your elbow and wrist. He or she will be able to advise you on this.

You may be given advice about your posture and ways to change an activity that may be causing your symptoms.

Complementary therapies

Acupuncture is commonly used to treat tennis elbow, and may help to relieve your symptoms, but there is conflicting evidence to show its effectiveness (See our common questions for more information). Speak to your GP or physiotherapist before trying acupuncture. If you decide to try it, check that your therapist belongs to a recognised professional body.

Non-surgical treatments

If over-the-counter painkillers and other treatments don't ease your pain, your GP may suggest a steroid joint injection (also known as a corticosteroid injection). A medicine that contains steroids (a type of hormone) is injected into the painful area of your arm. You may be given the steroid joint injection with local anaesthesia. This completely blocks pain from the area and you will stay awake during the procedure. Most people find steroid joint injections ease their pain initially, however they're often not effective over a long period of time. For this reason steroid joint injections are usually used as a last resort.

Extracorporeal shockwave therapy passes high-energy shockwaves through the skin of the painful area to relieve pain. Research has shown that shockwave treatment is safe but its effectiveness is unknown and further research is needed. This treatment is often only used if other treatments haven't worked for you. Speak to your physiotherapist for advice

Surgery

It's rare, but if you have severe tennis elbow that has been causing you problems for many months, you may have surgery. This aims to repair the damaged part of your tendon.

Prevention of tennis elbow

Tennis elbow is usually caused by overuse of your arm, so it can be prevented. A few sensible precautions include:

  • warming-up before activity with five minutes of gentle movements – this allows time for your muscles to adjust to the extra stresses and strains
  • trying not to do the same activity for long periods of time – take regular breaks
  • seeking advice early from your GP or physiotherapist if you notice a problem
  • stopping the activity that's causing the problem or find a different way to do it

To prevent a previous tennis elbow injury from coming back, you should:

  • rest between sessions
  • not play sport if your arm is painful
  • get professional advice on your technique and the equipment you're using if you play racquet sports regularly
  • perform exercises to strengthen the tendon in your arm, as advised by your physiotherapist

Video

See our video about tennis elbow:

How can I treat muscle sprains and strains at home

How do braces and elbow straps help to relieve my painful tennis elbow?

Answer

Orthotic devices, such as a brace, splint, cast, band or strap, aim to work by reducing the forces going through the tendon in your elbow. However, there is little evidence to show whether they're effective in treating tennis elbow.

Explanation

There are many different types of orthotic devices available to help manage your tennis elbow. They all claim to work in a similar way by limiting the amount of forces that go through your tendon. This in turn aims to reduce the amount of work your muscles do around your elbow and therefore helps to ease your pain. Although there is little evidence to show whether these devices are effective, you may want to try using one to see whether it works for you.

Most orthotic devices are worn just below your elbow joint. The device should be placed around your arm when your forearm muscles are relaxed and tightened firmly to a comfortable degree of tension.

If you have tennis elbow, it's important to rest your arm and to stop or change the activity that causes your pain. You may find wearing an orthotic device helpful to ease your pain. You will usually only need to wear them for a few weeks and you shouldn't wear them constantly.

Your physiotherapist may advise you to do exercises with or without wearing your orthotic device to help strengthen the muscles around your elbow and wrist as part of your treatment.

You can buy orthotic devices from some physiotherapists, pharmacies and sports shops. Speak to your physiotherapist about the best type of device for you.

What's the difference between tennis elbow and golfer's elbow?

Answer

Tennis elbow causes pain around the outside of your elbow and can spread to your forearm. Golfer's elbow is similar to tennis elbow but the pain occurs on the inside of your elbow.

Explanation

Tennis elbow is also known at lateral epicondylitis because it affects the outside of your elbow. Golfer's elbow is a similar condition but it affects the inside of your elbow. The medical term for golfer’s elbow is medial epicondylitis and it’s caused by overuse of the wrist tendon attached to the inside of your elbow.

Golfer's elbow is less common than tennis elbow. Golfer's elbow can be caused by a poor technique when playing golf or serving in tennis. The main symptoms of golfer's elbow are pain and tenderness on the inside of your elbow and sometimes a tingling and numb sensation in the fourth and little fingers of your hand on the affected arm.

Treatment of golfer's elbow is similar to that of tennis elbow. Initially you should rest your arm and stop any activity that makes your symptoms worse. You can take anti-inflammatory medicines, such as ibuprofen, and ice the injured area using an ice pack or ice wrapped in a towel to reduce swelling and bruising. Don't apply ice directly to your skin as it can damage your skin.

A physiotherapist can help to reduce your pain by trying various techniques such as exercise, deep tissue massage and acupuncture. He or she may also give you a programme of exercises to do that stretch your muscles and improve the movement and strength of your elbow and wrist. You may also find arm braces and straps helpful.

Steroid joint injections are rarely used and surgery may be an option if your symptoms become severe and continue for a long time.

Can corticosteroid injections treat my tennis elbow?

Answer

A steroid joint injection (cortisone) can be injected directly into the painful area around your elbow. This can help to reduce the pain in your arm but won't cure your tennis elbow.

Explanation

Steroid joint injections help to treat tennis elbow by relieving pain and inflammation.

Your doctor will inject the steroid around the tendon into the area that is most painful for you. Some people may experience slight discomfort at the site of the injection so it's often combined with a local anaesthetic to help prevent this. A local anaesthetic completely blocks pain from the area and you will stay awake during the procedure.

You may be advised to rest your arm after having a steroid joint injection and it may take a few days before you get any pain relief.

Pain relief from steroid joint injections may only last a few weeks or months and your pain may come back. There is little evidence to show the long-term benefit of these injections. You can usually only be given a maximum of three steroid joint injections in a year.

Steroid joint injections won't cure your tennis elbow so you may have to continue with self-help treatments and physiotherapy alongside your steroid joint injections.

Speak to your GP or physiotherapist for advice before having steroid joint injections to treat your tennis elbow.

Can tennis elbow be treated with acupuncture?

Answer

Although acupuncture is often used in the treatment for tennis elbow, there is little evidence to show whether it works or not.

Explanation

Acupuncture is a complementary treatment that involves puncturing the skin with needles in specific points to relieve pain.

There is conflicting evidence for the benefits of using acupuncture to treat tennis elbow. Some research suggests that acupuncture may ease pain and improve movement in your elbow over a few weeks but not in the long-term. However, the evidence isn’t clear and more research is needed.

If you wish to try acupuncture for elbow pain, you should check that your therapist is registered with a professional body. The British Acupuncture Council and the Acupuncture Association of Chartered Physiotherapists (AACP) has a list of members who are trained to provide acupuncture.