Tennis elbow

Tennis elbow is a condition causing pain around the outside of your elbow. It’s often experienced by people who do repeated wrist and arm movements, but the cause isn’t always known.

The pain is thought to come from swelling and/or small tears in the tendon attaching the muscles of your forearm (below the elbow) to the bone on the outside of your elbow. 

The medical name for tennis elbow is lateral epicondylitis or epicondylalgia because the pain is felt around the part of the humerus bone called the lateral epicondyle. In most cases, it is not possible (nor necessary) to specify exactly where the pain comes from.

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Many people who get tennis elbow work, or play sport, in a way 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, using a paintbrush or gardening
• twisting movements such as wringing clothes or using a screwdriver
• throwing sports, such as javelin or discus
• playing racquet sports, such as tennis, badminton or squash – despite being called tennis elbow, racquet sports are only thought to be the cause in about 5 in 100 cases.

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.

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:

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

Given rest from painful movements, and time, tennis elbow can get better on its own. For most people, tennis elbow will fully recover within a year. 

Visit your healthcare provider or physiotherapist if the pain continues after you have rested the elbow for 1 to 2 weeks, if there is throbbing pain that keeps you awake at night or if you notice your forearm muscles getting smaller (wasting).

To diagnose tennis elbow, your healthcare provider will examine you for:

• pain or tenderness when they feel the tendons and muscles at the upper arm bone, over the outside of the elbow
• pain near the elbow when your wrist is bent backwards or when you grip a hand (as in a handshake).

Further tests, such as ultrasound or MRIs (magnetic resonance imaging) aren't usually needed to diagnose tennis elbow.

Treatment for tennis elbow aims to reduce elbow pain and restore normal movement and function. Self-care and long term strengthening are the main ways to treat tennis elbow. Treatment may include physiotherapy and medication. Surgery is only an option if pain isn't relieved with continued self-care, strengthening exercises, physiotherapy and medication.

Self-care

Tennis elbow takes time to heal. Here are some things that may help ease the pain:

• Avoid the activity that causes the symptoms for at least 2 weeks.
• Apply an ice pack, such as 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.
• Use a special brace that wraps around the upper part of your forearm. Alternatively, wearing a wrist splint may ease pain by helping to rest the muscles that pull on your elbow. A splint or brace can often be bought over the counter from a pharmacy or from a mobility aid shop.

Physiotherapy

Strengthening the wrist and shoulder muscles is extremely important for the long term care of tennis elbow. A physiotherapist can give you exercises to gradually strengthen the muscles of your forearm and the shoulder. The physiotherapist will explore how the pain influences your life and make an individual plan with you. They will help you to work out how to move and achieve your daily activities in different ways if the pain continues.

Medicines

Anti-inflammatory medicines, such as ibuprofen may be helpful for a few days. Some anti-inflammatories are available as a cream or gel that can be rubbed directly over the painful area. If you can't take anti-inflammatory pain medication, other pain medication 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 many people find the pain comes back. You would need to rest the arm for a few days after a corticosteroid injection. Then you can slowly return to doing the progressive strengthening exercises and your usual activities.

Surgery for severe symptoms

Surgery is rarely considered – only when severe pain continues after 6 to 12 months of rest and treatment. Your healthcare provider can give you more information about this option.

Apps reviewed by Healthify

You may find it useful to look at some physiotherapy and exercise apps, pain management apps, and joint and bone health apps.

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. Doing the things listed below may help you prevent tennis elbow developing or coming back.

In general

• Avoid doing the activity that's causing pain, or find a way of doing it that doesn't make the pain worse.
• Strengthen your shoulder muscles and forearm muscles to spread the load to your larger muscles. 
• Slowly increase your forearm strength and ease your way gently back into twisting activities so you can return to your usual activities as soon as possible.

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 before playing to help avoid injury.
• Use lightweight equipment and enlarge the grip size to decrease the strain on your tendons.

If your symptoms are work-related

• Discuss your options with your employer.
• Seek help from an occupational physiotherapist or other healthcare provider. They will work with you to find strategies or solutions that allow you to continue with your job without making the pain worse.
• There may be:
  • other tasks you could do while your elbow is resting, or
  • changes that could be made to the way you work to reduce the risk of it reoccurring.
• If possible, swap between tasks that use your wrist and forearm differently, and take regular breaks when you're working.