Skip to main content

Tennis elbow (Lateral epicondylitis)

For the video/webinar on tennis elbow - please scroll down.

What?

The most common cause of pain on the outside or lateral aspect of the elbow is a condition called tennis elbow, also known as lateral epicondylitis. Despite its name, fewer than 10% of cases are a result of racquet sports. Tennis elbow is caused by a tendinopathy of the extensor muscles in the forearm. Tendons are structures that attach muscle to bone. In this case, attaching the extensor muscles of the forearm to the lateral epicondyle of the humerus (See video below for photo). Injury to the tendons can result in a tendinopathy which causes pain, swelling and weakness of the associated muscles. The main cause of tennis elbow is overuse or overloading of the extensor muscles of the forearm, leading to pain and difficulty when lifting and gripping. Tennis elbow can take up to 1-2 years to fully recover from, however treatment options such as exercise (Progressive loading) have been shown to help speed up this process.

Certain people can be more predisposed to having tennis elbow, such as:

  • Those aged 30 or older
  • Those in a manual job
  • Current or previous smokers
  • Those with a high BMI
  • Those taking medications such as fluoroquinolone, antibiotics or statins

Lateral elbow pain can also be caused by other issues, such as:

  • Osteoarthritis – characterised by morning stiffness and limitation to movement
  • Intra-articular loose bodies – associated with severe pain, clicking and limitation to movement
  • Cervical radiculopathy – pain referred from nerve irritation at the neck causing associated pain, pins and needles, numbness and weakness in the arm
  • Golfer’s elbow – similar cause and presentation to tennis elbow however with symptoms on the inside or medial aspect of the elbow
  • Cubital tunnel syndrome – entrapment of the ulnar nerve at the elbow leading to pins and needles and/or numbness in the ring and little finger
  • Radial tunnel syndrome – entrapment of the radial nerve at the elbow leading to pins and needles and/or numbness in the thumb and index finger and weakness of the thumb and/or wrist

If you have any neurological symptoms (pins and needles and/or numbness) or symptoms associated with trauma (e.g. hitting or falling onto your elbow) it is important that you consult a healthcare professional to determine what may be causing these symptoms.

Common symptoms:

  • Tenderness on the bony point or surrounding area on the outside of the elbow
  • Pain when writing or typing
  • Pain with lifting objects
  • Pain when gripping
  • Pain when straightening your elbow or your wrist
  • Pain when turning your forearm

Diagnosis:

Diagnosis will be confirmed by your physiotherapist based on presenting symptoms and associated physical tests. These include:

  • Tenderness on palpation of the outside of the elbow
  • Pain on repetitive activities e.g. writing and typing
  • Pain with resisted wrist and elbow extension
  • Pain with resisted middle finger extension

Cycle of symptoms:

A common problem with tendon injuries is what we call a cycle of symptoms. Tendinopathy often results in pain. Pain is a warning sign produced by your body to protect you from injury. Your body’s natural response to pain is to avoid painful activities which in turn leads to weakness of muscle groups due to inactivity. This weakness then causes further pain as the muscle group is no longer able to cope with previous loads and leading to increased strain through the muscle when doing simple activities. This then continues in a cycle with tendons becoming more painful and weaker until it significantly impacts on your day-to-day activities.

It is important to note the pain does not always indicate that you are causing damage and you should not be fearful of low level pain. This is important to consider in order to break the cycle of symptoms.

Treatment options for tennis elbow:

  • Exercise
  • Pain relief
  • Symptom modification
  • Corticosteroid injection
  • Shockwave therapy

Exercise

Exercise has been shown to be very effective in treating tennis elbow by reducing pain and the likelihood of needing further intervention. It can both speed up recovery and make everyday activities easier. Exercise is often the first treatment option considered and is seen as the best management of tennis elbow.

Some mild pain is expected when completing exercises for tennis elbow. Any pain that persists for greater than 1 hour after exercise, likely means that you may have overworked the area. If this occurs, reduce the number of exercises and repetitions you are doing and build this up gradually as they become easier. This allows the tendons and muscles to adapt to higher loads over time making day-to-day activity easier. Often when pain levels low, you may feel as though you can do more, however this can then lead to increased pain as muscles/tendon are not prepared for these activities. This increase in pain comes back to the cycle of symptoms discussed previously as people tend to rest which in turn leads to weakness. Gradual increase in activity is key to effective rehabilitation.

Isometric exercises have been shown to be useful in acute/early stages of tennis elbow. These involve contracting your muscles without moving your forearm/wrist/hand.

For more exercise idea's/progressions please see the below video.  

 

Medications

Over the counter medications such as paracetamol and topical anti-inflammatory gels may be helpful in reducing pain the early stages of injury. Some may suffer skin rashes when using gels therefore it is important to check with the GP/pharmacist before taking medication.

Symptom modification

Symptom modification involves changing the way you do things to avoid aggravating your injury. For example, avoiding lifting heavy objects, forceful gripping or twisting actions that may aggravate symptoms. If these activities are unavoidable try to alter them so they are not painful, for example, when lifting heavy objects do so with your elbows bent and palm facing upwards.

If you feel as though symptoms are due to work, it may be worth discussing this with your employer or occupational health department as a means to aid recovery. Adaptations to work could include, to mix work patterns, increase number of rest breaks, to change the way objects are handled, and to make modifications to the work environment.

Ergonomics

If elbow pain is exacerbated by activities such as computer work, consider altering sitting position, position of key board, and shape and position of your mouse.

Tennis elbow brace

These can ease pressure on tendons when keeping active/while at work although you would be discouraged from wearing this all the time. These can be purchased at a low price on many online stores.

Smoking

Reducing or quitting smoking can help with recovery from injuries such as tennis elbow. This is because smoking negatively impacts on the way the body heals which can delay recovery.

Corticosteroid injection

In the past, corticosteroid injections have been offered as they may lead to a reduction in pain however there is debate as to the long term effects. Some evidence shows that corticosteroid injections can lead to worse long term outcome when compared to exercise and other treatment options.

Shockwave therapy

This has been shown to help increase tissue repair and cell growth in some conditions. However, its effectiveness in treatment of tennis elbow is debated when compared to proven treatments such as, exercise and treatment, and can be uncomfortable to receive.

Find us on

Rydym yn croesawu gohebiaeth a galwadau ffôn yn y Gymraeg neu'r Saesneg. Atebir gohebiaeth Gymraeg yn y Gymraeg, ac ni fydd hyn yn arwain at oedi. Mae’r dudalen hon ar gael yn Gymraeg drwy bwyso’r botwm ar y dde ar frig y dudalen.

We welcome correspondence and telephone calls in Welsh or English. Welsh language correspondence will be replied to in Welsh, and this will not lead to a delay. This page is available in Welsh by clicking ‘Cymraeg’ at the top right of this page.