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Tennis elbow

Tennis elbow is a condition that causes pain around the outside of your elbow. The medical term for tennis elbow is lateral epicondylitis. This is because it can cause pain near your lateral epicondyle, which is the bony part of your outer elbow.

Tennis elbow is a type of tendinopathy, which means it affects your tendons. It develops when the tendon that joins your forearm muscles to the outside of your elbow become inflamed or has small tears. This causes pain and tenderness. The tendon is called the common extensor tendon. Because of this, the condition is sometimes known as tendonitis of the common extensor origin.

Tennis elbow is a common condition that affects between one and three people in every 100. Anyone can get tennis elbow, but you’re most likely to get it when you’re aged 40 to 50. It usually develops in the arm you use most; for example if you’re left-handed it usually develops in your left elbow.

It’s likely to get better over time, unless you keep doing the activities that caused the problem. Depending on how severe your tennis elbow is, it can last between six weeks and two years. Sometimes, it can come back again in the future.
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  • Symptoms 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 may develop gradually over time and you may not be able to link them to any particular event or injury. They may come one to three days after you carried out the activity that caused the problem. The pain can vary from mild discomfort to severe pain that can stop you holding a cup, for example.

    Your pain may get worse when you grip something, for example holding a cup or shaking someone's hand firmly. It may also get worse when you bend your wrist backwards against a force, for example when using a screwdriver or doing backhand in tennis. You may also find that you have a weak grip and a stiff elbow.

    Many people with mild symptoms of tennis elbow find that their pain eases with rest and self-help treatments. If your symptoms don't improve after a couple of weeks, see your physiotherapist or GP for advice. If you have severe elbow pain, can't move your elbow or have loss of feeling, contact your GP straight away.

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  • Diagnosis Diagnosis of tennis elbow

    You may not need to see your physiotherapist or GP if you think you have tennis elbow. You may be able to treat it at home. But if your symptoms get worse and self-help and over-the-counter painkillers aren't working, see your physiotherapist or GP for advice.

    Your physiotherapist or GP will ask you about your symptoms and examine you. He or she may ask about your medical history, hobbies and work. They’ll usually be able to diagnose tennis elbow by examining your arm and asking how your symptoms developed and what makes them worse.

    Your condition is likely to settle down, so you probably won’t need further tests. If your doctor refers you to a specialist, they may ask you to have some imaging tests such as an ultrasound scan. Ultrasound uses sound waves to produce an image of the inside of the body.

    You may also have other tests, such as an X-ray, to rule out other causes of your pain, such as a broken bone.

  • Treatment Treatment of tennis elbow

    The treatment for tennis elbow partly depends on how long you've had it and which treatments you've already tried. To make a full recovery, you’ll need to rest your arm and avoid the activities that make it worse. This also gives your tendon time to heal. Most people find that their tennis elbow improves within a year.

    Self-help

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

    • Rest your elbow and tendon. If the problem is a result of an activity at work, contact your employer's occupational health adviser, if available, or talk to your employer. Ask if you can change your assigned tasks to allow your arm time to recover.
    • Lift objects with your palm facing up, not down, as this will put less strain on your damaged muscles.
    • If you need to continue some activities, take regular breaks. Your arm will need rest to improve.
    • Putting a cold compress or a heat pack on your elbow can ease your pain for a while. Don't apply ice or a heat pack directly to your skin, as it could damage it.
    • You might want to try wearing a strap, splint or brace around your forearm to help relieve the strain on your tendon. Some studies have shown that one of these might help you to carry out your daily activities for a few weeks. Although they are safe, there’s not much proof that they work. If you want to try one, you can buy them from some physiotherapists, pharmacies and sports shops. Follow instructions for their use and ask your doctor or physiotherapist if you need more advice.
    • If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Non-steroidal anti-inflammatory drugs (also known as NSAIDS), such as ibuprofen, are available as a cream or gel. You can put this directly on your skin, or you can take them as a tablet. If you use creams or gels with ketoprofen in, you’ll need to protect your arm from sunlight for two weeks. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.
    • Gentle exercises for tennis elbow can help to slowly increase your muscle’s strength without causing damage. Ask your doctor or physiotherapist to talk you through how to do these.

    Medicines

    If your tennis elbow doesn’t get better, comes back, or your pain is severe, your GP may suggest a steroid joint injection. A steroid (a type of hormone) will be injected into the painful area of your arm.

    Most people find steroid joint injections ease their pain at first but they can stop working after a few weeks. As with every procedure, there are some risks linked with steroid joint injections. See our FAQs section for more information. If you have any questions, ask your doctor to explain how these risks apply to you.

    Physical therapies

    Your GP may refer you to a physiotherapist. A physiotherapist is a health professional who specialises in maintaining and improving movement and mobility. He or she may try various techniques to reduce your pain. These may include exercises, deep tissue massage, ultrasound therapy and laser therapy. Physiotherapy might not help immediately, but can help to relieve pain in the long-term.

    Complementary therapies

    Experts don’t recommend acupuncture for treating tennis elbow. This is because there isn't enough proof that it will help your tennis elbow. See our FAQs for more information. Speak to your physiotherapist or GP before trying acupuncture. If you decide to try it, check that your therapist belongs to a recognised professional body.

    Non-surgical treatments

    Some other treatment options for tennis elbow are listed below. There isn't enough proof that they work well, although they are usually safe. Your doctor can explain how well these might work for you and any risks involved. Some of these are described below.

    • A sample of your blood can be taken and injected back into your elbow. This is known as an autologous blood injection and is thought to help relieve pain.
    • A sample of your blood can be taken and the plasma and platelets injected back into your elbow. This is known as a platelet-rich plasma injection.
    • You can have an injection of botox (botulinum toxin A) into your elbow. This will temporarily prevent the muscles moving and allow them time to rest and heal. A downside of this treatment is that you won’t be able to move some of your fingers for a few months.
    • You may be able to have shock wave therapy. This passes high-energy shock waves through the skin of the painful area, which can help to ease pain.

    Surgery

    Tennis elbow usually gets better using the treatments listed above. But, if after six months to two years it hasn’t got better, your doctor may suggest you have surgery. This aims to repair or remove the damaged part of your tendon.
  • Physiotherapy

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  • Causes Causes of tennis elbow

    Tennis elbow is usually caused when the muscles and tendons become damaged. This can happen if you’re repeating the same motion over and over again. It can also happen if other muscles in your arm are weak, or if you’re using the wrong technique for the task you’re performing.

    If you play a racquet sport, such as tennis or badminton, it can cause tennis elbow. But you may be surprised to know that most people who get tennis elbow don't play tennis.

    The most common cause of tennis elbow is doing activities where you’re repeatedly and forcefully gripping and twisting your wrist. For example, you're more likely to develop the condition if you’re a plumber, bricklayer, painter, decorator or gardener. Carrying heavy loads can also cause tennis elbow. If you spend more than 20 hours at a computer each week (especially for many years), you’re also more likely to get tennis elbow. This is because these activities can cause minute tears in your arm muscles and tendons and inflammation.

  • Prevention Prevention of tennis elbow

    You may be able to prevent tennis elbow by taking steps to protect your arm muscles and tendons. A few precautions are listed below.

    • Think about the repetitive actions you do and try to avoid or change them.
    • Take breaks during or between tasks that involve using your arms.
    • If you're lifting, carry the weight close to your body and keep your palms facing upwards.
    • If you play a sport, make sure you're using the right technique. You may want to get a coach to help you with this.
    • Make sure any equipment you use is adjusted correctly, for example make sure your racquet isn't too tightly strung.
  • Can corticosteroid injections treat my tennis elbow? 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 it can’t cure tennis elbow.

    More information

    Steroid joint injections help to treat tennis elbow by relieving pain and inflammation. Your doctor may recommend you try one if your tennis elbow is giving you severe pain.

    Your doctor will inject the steroid into the painful area. It can hurt when you have the injection, so you’ll probably have a local anaesthetic injected at the same time to help prevent this. A local anaesthetic completely blocks pain from the area and you’ll stay awake during the procedure.

    You may have pain relief for a few weeks after an injection, but your pain may come back later. There is little proof to show that these injections work in the long term. You can usually have up to three steroid joint injections in an elbow, and these should be at least six weeks apart.

    Steroid injections have some side-effects (unwanted but mostly temporary effects you may get after having the procedure). They can cause some damage beneath your skin, and some loss of colour to your skin.

    They won't cure your tennis elbow, so you may need to continue with self-help and physiotherapy too. 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? Can tennis elbow be treated with acupuncture?

    Answer

    Experts don’t recommend acupuncturefor tennis elbow, because there isn't enough proof that it works.

    More information

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

    Studies into acupuncture use for tennis elbow have had mixed results. Some studies suggest that acupuncture may help relieve pain for a little while (eg a day), but others didn’t find a benefit. More scientific research is needed before we can be sure how well acupuncture really works for tennis elbow treatment.

    If you want to try acupuncture for elbow pain, 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 trained to provide acupuncture.

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

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

    Answer

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

    More information

    Tennis elbow (also called lateral epicondylitis) 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. It develops when you overuse the wrist tendon attached to the inside of your elbow.

    Golfer's elbow is less common than tennis elbow. It can be caused by sports that involve gripping or throwing, repetitive elbow movements (such as DIY or computer use), and vibrating tools. The main symptoms of golfer's elbow are pain and tenderness to the inside of your elbow. This may get worse when you twist your wrist. Sometimes you may have a tingling and numb sensation in the fourth and little finger of your hand. Treatment of golfer's elbow is similar to that of tennis elbow.

  • Resources Resources

    Further information

    Sources

    • Tennis Elbow. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2015
    • Lateral epicondylitis (tennis elbow). The Merck Manuals. www.merckmanuals.com, published October 2014
    • Strandring, S. Gray's anatomy: the anatomical basis of clinical practice. 40th ed. London: Elsevier; 2008
    • Chesterton LS, Mallen CD, Hay, EM. Management of tennis elbow. Open Access J Sports Med 2011; 2: 53−59. doi:10.2147/OAJSM.S10310
    • Lateral epicondylitis. Medscape. www.emedicine.medscape.com, published 12 January 2015
    • Tennis elbow and golfer’s elbow. PatientPlus. www.patient.co.uk/patientplus.asp, published 8 May 2015
    • Map of Medicine. Epicondylitis. International View. London: Map of Medicine; 2013 (Issue 3)
    • Rehabilitative measures for treatment of pain and inflammation. The Merck Manuals. www.merckmanuals.com, published August 2013
    • Johnson GW, Cadwallader K, Scheffel SB, et al. Treatment of lateral epicondylitis. Am Fam Physician 2007; 76(6): 843−48. www.aafp.org
    • Corticosteroids and corticosteroid replacement therapy. PatientPlus. www.patient.co.uk/patientplus.asp, published 20 January 2015
    • Tennis elbow. Arthritis Research UK and the Chartered Society of Physiotherapy. www.csp.org.uk, published October 2012
    • Local and regional anesthesia. Medscape. www.emedicine.medscape.com, published 3 June 2013
    • Tendonitis. Medscape. www.emedicine.medscape.com, published 1 October 2014
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    Reviewed by Hemali Bedi, Bupa Health Information Content Team, June 2015.

    Peer reviewed by Dr Leon Creaney.

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