Tennis elbow is a painful condition of the elbow, which commonly affects active individuals over the age of 30 years. The condition, which is also known as “lateral epicondylitis”, usually commences with insidious onset of pain on the outer aspect of the elbow. Occasionally the pain may follow an injury to the elbow. The condition is not specific to tennis players nor athletes. It often occurs in individuals in manual occupations or those who perform repetitive lifting or carrying tasks.

How does Tennis elbow develop?

The condition is believed to result from overuse. The tendons of the elbow suffer wear and tear over time. This results in degeneration of the tendons and occasionally there may be microscopic or partial tears in the tendon. Some natural healing may take place but often there is a process of repeated breakdown and incomplete healing which results in pain.

How is Tennis elbow diagnosed?

A diagnosis of Tennis elbow is made from the history of pain localised to the outer aspect of the elbow and occasionally down the forearm. Pain is usually intermittent and often experienced with activities. Pain may be associated with weakness of grip. Examination shows localised tenderness on the outer aspect of the elbow and pain with certain provocative manoeuvres such as extending the wrist against resistance. An X-ray may sometimes show bone spurs or calcium deposits. An ultrasound scan or MRI may be performed to examine the state of the tendons. If associated nerve pain is suspected, electromyography (EMG) or nerve conduction tests may be requested.

How is Tennis elbow treated?

In the early phase, pain may be controlled with activity modification and the use of pain relieving or anti-inflammatory medication. In most individuals, Tennis elbow is a self-limiting condition that often resolves slowly over a variable period of time ranging from 6-18 months.

Supervised physiotherapy: You may be advised to see a physiotherapist to start a regime of specific treatment that includes deep friction, stretching of the affected tendons and eccentric strengthening exercises. There is good evidence to suggest that supervised physiotherapy improves symptoms.

Instructions on a therapeutic exercise program for tennis elbow can be downloaded from the Orthoinfo website.

The British Elbow and Shoulder Society (BESS) website has an Instructional video on Exercises for Tennis elbow.

Clasp: Wearing an epicondylitis clasp on the forearm will often help ease symptoms particularly if worn during activities. It may also act as a reminder to modify activities.

Shockwave therapy: This is a non-invasive treatment, which aims to stimulate the body’s natural healing process for this condition. At least three treatments are required at weekly intervals.

Steroid injection: A steroid injection placed accurately into the tendon origin will often provide good short to medium term pain relief allowing progress to be made with physiotherapy. The injection will not cure the condition. It is not advisable to have multiple injections.

Platelet-rich-plasma (PRP) injection: A small amount of venous blood is withdrawn from the patient and spun in a special centrifuge for 5 min. This yields a sample of Plasma rich in platelets, which are the blood cells that play an important role in healing. A small volume (approximately 2ml) is injected into the origin of the tendon using a multiple puncture technique. The procedure is painful and shows some benefit compared with steroid injections over the long term.

Surgery: In a small minority of patients, in whom symptoms have persisted despite adequate nonoperative treatment, it may be appropriate to undertake surgical treatment. Surgery may be performed arthroscopically (“key-hole” surgery) or open and the most appropriate technique for your condition will be discussed with you. Arthroscopic surgery may be preferred to open surgery as it leaves smaller scars, causes less tissue damage, allows the inside of the joint to be examined and is associated with less pain, an easier recovery and better long term outcome. The origin of the affected extensor tendon is released from the bone and the bone may be drilled, abraded or treated with microfracture to promote healing. Following surgery symptoms will usually settle over a period of time. For further information on surgical treatment, please refer to the section on Surgery for tennis elbow.