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Tennis elbow

Tennis elbow is the common name for a condition that causes pain around the outside part of your elbow.

The medical term for tennis elbow is lateral epicondylitis because it often affects the outside of your elbow bone, which is called the lateral epicondyle. This is the bony area you can feel on the outside of your elbow. 

Tennis elbow develops when the tendons that join your forearm muscles on the outside of your elbow become inflamed. This causes pain and tenderness. The tendon is called the common extensor tendon.

Tennis elbow is a common condition that affects between one and three people in every 100. Anyone can get tennis elbow, but it's most likely to develop when you’re between the age of 40 and 50. Depending on how severe your tennis elbow is, it can last between six weeks and two years.

Tennis elbow usually develops in the arm you use most; for example if you’re left-handed it usually develops in your left elbow.

Tennis elbow is usually caused when the muscles and tendons become damaged from overuse. This can happen if you’re repeatedly doing the same motion over and over again. It can get worse if you keep doing the activity that causes your pain.

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Details

  • 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 can develop gradually over time and you may not be able to link them to any particular event or injury. The pain can vary from mild discomfort to severe pain which can disrupt your sleep.

    Your pain may get worse when you:

    • grip something, for example holding a pen or shaking someone's hand
    • twist your forearm, for example turning a door handle
    • use your keyboard or mouse
    • fully lengthen (extend) your arm

    Many people with mild symptoms of tennis elbow find that their pain eases with rest and self-help treatments. However, if your symptoms don't improve after a couple of weeks, see your GP or physiotherapist for advice.

    If you have severe elbow pain, can't move your elbow joint or have any loss of feeling, you should see your GP straight away.

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  • Diagnosis Diagnosis of tennis elbow

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

    Your GP or physiotherapist will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP can usually diagnose tennis elbow by examining your arm and finding out how your symptoms developed.

    You probably won’t need further tests. However, your GP or physiotherapist may recommend having an X-ray to rule out other conditions, such as arthritis, that cause elbow pain.

  • Treatment Treatment of tennis elbow

    The treatment for tennis elbow depends on how severe it is and how much it affects your day-to-day life. To make a full recovery, you may need to change the way you use your arm. This is so your tendon can rest and has time to heal.

    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 by changing the activity that caused the problem. If the problem has developed as a result of an activity at work, contact your employer's occupational health adviser, if available, or talk to your employer. They can give you advice on how to change the activity that caused the problem, allowing your arm to heal, and preventing the injury from recurring in the future.
    • Putting a cold compress or a heat pack on your elbow can help to ease your pain. Hold this against your elbow for 10 minutes every two hours. Don't apply ice or a heat pack directly to your skin as it can damage your skin.
    • Wear a strap, splint or brace around your forearm to help relieve the strain through your tendon. You can buy braces and splints from some physiotherapists, pharmacies and sports shops. Don't wear a strap or splint all the time. (See our FAQs for more information)
    • If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Non-steroidal anti-inflammatory painkillers (also known as NSAIDS), such as ibuprofen, are available as a cream or gel that you can put directly on your skin, or you can take them as a tablet. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
    • Gentle exercises, specifically for tennis elbow, can help to ease stiffness, strengthen your joint and help you to get the full amount of movement back.

    Medicines

    If over-the-counter painkillers and other treatments don't ease your pain, or your pain is severe, your GP may suggest a steroid joint injection. A steroid (a type of hormone) is injected into the painful area of your arm.

    Most people find steroid joint injections ease their pain initially. However, they can stop working over a long period of time. If you have had tennis elbow for more than six weeks then a steroid injection may not work.

    Physical therapies

    Your GP may refer you to a physiotherapist. He or she may try various techniques to reduce your pain. These may include exercises, deep tissue massage, ultrasound therapy and laser therapy.

    Complementary therapies

    Acupuncture is sometimes used to treat tennis elbow, and may help to relieve your symptoms. However, there is conflicting evidence to show whether it works, or not. See our FAQs for more information. Speak to your GP or physiotherapist before trying acupuncture. If you decide to try it, check that your therapist belongs to a recognised professional body.

    Non-surgical treatments

    Extracorporeal shock wave therapy passes high-energy shock waves through the skin of the painful area, which can help to ease pain. Research has shown that shock wave treatment is safe but how well it works isn’t known and further research is needed. This treatment is often only used if other treatments haven't worked for you. Speak to your physiotherapist for advice.

    Surgery

    Tennis elbow usually gets better using the treatments listed above. However, if it doesn’t get better after other treatments, or if your pain is severe, your doctor may suggest surgery. This aims to repair or remove the damaged part of your tendon.

  • Physiotherapy

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including physiotherapy.

  • Causes Causes of tennis elbow

    If you play a racquet sport, such as tennis or badminton, it can cause tennis elbow. However, most people who get tennis elbow don't play tennis.

    The most common cause of tennis elbow is doing activities where you’re repeatedly gripping and twisting your wrist. For example, if you’re a carpenter or plasterer, or if you use a computer mouse, you’re more likely to develop tennis elbow.

  • Prevention Prevention of tennis elbow

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

    • Think about the actions you do. Be aware of your position or grip style and change them if necessary.
    • Take a short break during or between tasks that involve twisting your wrist or gripping.
    • Try using a splint. If you play sports such as tennis, make sure you have the right racquet and that you're using the right technique when you're playing.
  • FAQs FAQs

    How do braces and elbow straps help to relieve pain?

    Answer

    Orthotic devices, such as braces, sleeves and straps, aim to work by reducing the forces going through the tendon in your elbow. They can help to reduce the amount of pain you have from tennis elbow.

    Explanation

    There are many different types of orthotic devices available to help manage your tennis elbow. Most orthotic devices are worn just below your elbow joint. They all claim to work in a similar way, by reducing the forces that go through your tendon. This in turn can reduce the amount of work your muscles do around your elbow and therefore helps to ease your pain.

    There is some evidence to show that certain types of braces and sleeves can ease pain if you have tennis elbow. Your GP or physiotherapist can give you advice about which one to use.

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

    Answer

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

    Explanation

    Tennis elbow is also called lateral epicondylitis because it 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 and 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 a poor technique when playing golf or serving in tennis. The main symptoms of golfer's elbow are pain and tenderness on the inside of your elbow. Sometimes you may have a tingling and numb sensation in the fourth and little fingers of your hand on the affected arm.

    Treatment of golfer's elbow is similar to that of tennis elbow. Initially you should rest your arm and stop any activity that makes your symptoms worse. You can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    You can also put ice on the painful area, using an ice pack or ice wrapped in a towel, to reduce swelling and bruising. Don't apply ice directly to your skin as it can damage your skin.

    A physiotherapist can help to reduce your pain by using various techniques such as exercise, deep tissue massage and acupuncture. He or she may also give you a programme of exercises to do that stretch your muscles and improve the movement and strength of your elbow and wrist. You may also find arm braces and straps helpful.

    Steroid joint injections are rarely used and surgery may be an option if your symptoms become severe and continue for a long time.

    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.

    Explanation

    Steroid joint injections help to treat tennis elbow by relieving pain and inflammation.

    Your doctor will inject the steroid into the area that is most painful for you. It can hurt when the injection is put in, so it's often combined with a local anaesthetic to help prevent this. A local anaesthetic completely blocks pain from the area and you will stay awake during the procedure.

    You may only have pain relief for a short while after a steroid joint injection and your pain may come back. There is little evidence to show the long-term benefit of these injections. You can usually only have a maximum of three steroid joint injections in a year.

    Steroid joint injections won't cure your tennis elbow, so you may have to continue with self-help treatments and physiotherapy alongside your injections.

    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?

    Answer

    Although acupuncture is often used as a treatment for tennis elbow, there isn’t enough evidence to show whether it works or not.

    Explanation

    Acupuncture is a complementary treatment that involves puncturing the skin with needles in specific points to relieve pain. Some physiotherapists use acupuncture as part of treatment for tennis elbow.

    There is conflicting evidence about using acupuncture to treat tennis elbow. Some research suggests that acupuncture may help to ease pain and improve movement in your elbow over a few weeks but not in the long-term. However, the evidence isn’t clear and more research is needed.

    If you wish to try acupuncture for elbow pain, you should 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 who are trained to provide acupuncture.

  • Resources Resources

    Further information

    Sources

    • Tennis Elbow. NICE Clinical Knowledge Summaries. www.cks.nice.org.uk, published October 2012
    • Tennis elbow. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published September 2009
    • Specific elbow conditions. Arthritis Research UK. www.arthritisresearchuk.org, accessed 23 April 2013
    • Lateral Epicondylitis Surgery. eMedicine. www.emedicine.medscape.com, published February 2013
    • MacCuley D. Oxford handbook of sport and exercise medicine. 2nd ed. Oxford: Oxford University Press, 2007: 386–87
    • Tennis elbow. British Acupuncture Council. www.acupuncture.org.uk, published December 2011
    • Extracorporeal shockwave therapy for refractory tennis elbow. National Institute for Health and Care Excellence (NICE). 2010. www.guidance.nice.org.uk
    • Tennis elbow. American Association for Surgery of the Hand. www.assh.org, accessed 24 April 2013
    • Medial Epicondylitis. eMedicine. www.emedicine.medscape.com, published October 2012
    • Green S, Buchbinder R, Barnsley L, et al. Acupuncture for lateral elbow (review). Cochrane Database of Systematic Reviews 2002, Issue 1. doi:10.1002/14651858.CD003527
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    Reviewed by Dylan Merkett, Bupa Health Information Team, July 2013.

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