Tennis elbow

Tennis elbow is a common musculoskeletal condition caused by overuse of the muscles and tendons in your forearm near to your elbow joint. It's caused by any activity that involves repetitive movement in your elbow, wrist and forearm.

It can affect anyone but is most common in people aged 30–50 years. About 1 to 3% of people have the condition and it occurs in men and women equally. Although the movement of your elbow joint isn’t restricted, it can be painful and make some everyday tasks difficult.

You’re more likely to develop tennis elbow if you have unfit forearms and suddenly start using these muscles a lot more than before.

In most cases, tennis elbow goes away after about a year with simple treatments and avoiding the repetitive activity that caused it.

Causes of tennis elbow
Around your elbow joints are muscles that move your elbow, wrist and fingers. Tendons connect some of these muscles to the bony lump on the outside of your elbow. When your muscles and tendons that are attached to your elbow and help to straighten your wrist are overloaded, tiny tears can form causing a thickening of the tendon. Over time, this can become painful.

Activities which may cause tennis elbow include:

• Decorating
• DIY and gardening
• Work that requires repeated gripping and twisting
• Playing a musical instrument
• Playing tennis
• Repeated use of a computer mouse

A similar condition causing pain on the inside of the elbow is golfer’s elbow (also known as medial epicondylitis).

The main symptom of tennis elbow is pain that:

• Gradually increases over time
• Can spread to your forearm, wrist and fingers
• May get worse when you use the muscles to do simple tasks like using a knife or fork, hold a cup or straighten your arm fully
• Is felt when you push your middle finger backwards

Tennis elbow usually affects one arm more than the other (usually the dominant arm).

You should see your GP if the pain is affecting you or has lasted a long time.

Your doctor will discuss your symptoms and will carry out simple examinations; for example, to see if you have pain when you stretch out your fingers and flex your wrist while your elbow is extended.

Occasionally, your doctor will arrange an ultrasound scan, X-ray or MRI scan to rule out other conditions.

They'll then be able to advise an effective tennis elbow treatment.

Tennis elbow is a self-limiting condition. If you stop the activity that caused it, it may eventually go away by itself. However, there are some things you can do to help reduce pain and speed recovery:

• If advised by your doctor, take painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation – creams and gels may cause fewer side effects, but these will not improve the condition in the long-term
• Rest your arm and avoid activities that make the pain worse – you may need to talk to your employer if your work environment is worsening your condition
• Use ice packs regularly – if you do not have an ice pack, a bag of frozen peas wrapped in a tea towel will work just as well
• Elbow supports and wrist splints to protect your elbow and rest the muscles that pull on the elbow until symptoms ease
• Massaging your arm may also help

In some instances, your doctor may suggest treatment for your tennis elbow. This could include:

• Physiotherapy – laser therapy and ultrasound have all been shown to be successful in improving long-term tennis elbow symptoms
• Steroid injections to reduce pain and inflammation. These can be effective in the short term but don’t work as well after six months. You’ll need to rest your arm even if the injections relieve you of pain, and you should be cautious of repeating injections in the same area. Side effects of steroid injections may include pain, shrinking of fatty tissue or loss of colour around the injection site
• Extracorporeal shockwave therapy (ESWT) to help improve healing in your tendon
• Platelet-rich plasma (PRP) injections to speed up your recovery – this is a relatively new treatment and involves separating platelets and other healing factors from a sample of your blood. These are then injected into your area of pain to promote healing

In severe cases, tennis elbow treatment may involve Botox injections or tendon surgery. Botox injections into the forearm are effective in relieving symptoms, however, they can cause a loss of motion in the fingers. Tendon surgery is the surgical removal of the damaged part of the tendon, though this is rarely needed.

If you rest your arm well and avoid activities that cause your symptoms then your tennis elbow will probably heal by itself. Adequate rest and some painkillers are usually all most people need.

You can expect your tennis elbow symptoms to last anywhere between six months to two years. Around 90% of people with tennis elbow will find they make a full recovery in less than a year. However, there’s a risk that the condition could return in future.

Tennis elbow is often caused by a sudden increase in the use of your forearm, which usually can’t be avoided. However, increasing the strength of the muscles in your forearm may help prevent developing tennis elbow again. You should exercise and strengthen your forearm muscles while avoiding any twisting movements – you may want to see a physiotherapist for advice on how to do this.

If your tennis elbow has been brought on by playing sports, you could seek some professional advice about your technique. If it has been caused by repetitive actions at work, you may want to speak to a physiotherapist who can suggest ways to avoid the injury occurring again in future.

What is the best treatment for tennis elbow?

There’s no best method for treating tennis elbow. The treatment your doctor suggests will depend on the severity of your condition. In most cases, painkillers, rest and ice is sufficient to relieve symptoms. Surgery or Botox injections may be needed for more severe cases of tennis elbow.

How long does it take for tennis elbow to heal?

You can expect your tennis elbow symptoms to persist between six months to two years. However, 90% of people with the condition make a full recovery in less than a year.

What happens if tennis elbow goes untreated?

In a lot of cases, the condition will go away without treatment. However, you’ll need to rest the arm fully for this to happen.

What exercises can I do to fix tennis elbow?

You should perform exercises that strengthen your forearm muscles, while avoiding any twisting movements. A physiotherapist can advise you on what you can do.