Tennis elbow

Tennis elbow is a common condition that causes pain in your forearm and around the outside of your elbow. Despite its name, most people don’t get it from playing tennis. It’s usually caused by repeated movements. For example, from playing a whole range of sports or doing repetitive activities like hammering or typing. It usually gets better with rest and over-the-counter painkillers.

What is tennis elbow?

Tennis elbow is a type of tendinopathy, which means it affects your tendons. It develops when your common extensor tendon (which joins your forearm muscles to the outside of your elbow) develops tiny tears and then thickens and swells. This causes pain and tenderness.

Tennis elbow is a common condition that affects between one and three people in every 100. Anyone can get tennis elbow, but you are most likely to get it in your 40s and 50s. You can get it in both arms, but it usually develops in the arm you use most.

It usually develops gradually and, depending on how severe it is, can last between six months and two years. Sometimes, it can come back in the future.

Symptoms of tennis elbow

The most common tennis elbow symptom is pain and tenderness on the outside of your elbow and in the muscles of your forearm. This usually gets worse as you bend and extend your elbow. You’ll probably be able to move your elbow fully and it will feel normal apart from the pain. The pain can vary from mild discomfort to severe pain that keeps you awake at night.

You may be able to link the start of your symptoms to doing a particular job or an action using your forearm or elbow. Doing this action usually makes the pain worse. Gripping actions can also make the pain worse. So, you might find it painful to do things like hold a cup or open a jar. 

Causes of tennis elbow

Tennis elbow develops when the muscles and tendons in your forearm become damaged. This happens if you’re repeating the same motion over and over again. Tiny tears develop in the muscles and over time that leads to swelling and thickening.

Some activities, situations and jobs make developing tennis elbow more likely. These include:

• any job where you are doing a lot of heavy lifting or using heavy tools
• jobs where you are making repeated movements in an awkward position – for example, squeezing or twisting movements – that can include typing and using a mouse
• movements in your forearm that you’re not used to – for example, taking up a new hobby, doing DIY such as hammering or painting, or moving to a new house
• being unfit or having a poor technique when you’re playing racquet sports such as tennis – for example, not holding the racquet properly

Self-help for tennis elbow

Most people who have tennis elbow find that their symptoms get better when they rest their arm and take-over-the counter painkillers. If you do this and still have symptoms after six weeks or so, see your Doctor. 

There are plenty of things you can do to treat your symptoms yourself, especially if the pain is mild. These include the following.

• Rest your elbow and arm as much as you can. Try not to do activities and movements that make your pain worse – for example, lifting things, gripping things or twisting your arm. If you need to lift something heavy, bend your elbow and make sure the palms of your hands are facing upwards. 
• Use  such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs are medicines such as ibuprofen and voltarol. You can use them as a gel, which you rub onto the area where the pain is, or you can take ibuprofen as a tablet. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.
• A cold compress on your elbow may temporarily relieve the pain. You can use a bag of frozen peas wrapped in a tea towel or an ice pack. Alternatively, a heat pack may help. You can buy reusable ice packs, heat pads and microwavable heat bags. Don't put an ice or a heat pack directly onto your skin because without a covering these could damage your skin. Only use it for about 15 minutes every couple of hours.
• You could try wearing a special tennis elbow strap, clasp, splint or brace to support your forearm when you’re doing activities that can make the pain worse. These supports are sometimes called epicondylitis clasps and you can buy them from some chemists and sports shops.
• If your symptoms get worse because of an activity you do at work, contact your employer's occupational health adviser or talk to your employer. Ask if you can change your tasks, take more breaks or mix your work patterns to allow your arm time to recover.

Diagnosis of tennis elbow

You may not need to see a doctor 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, contact your Doctor for advice.will usually be able to diagnose tennis elbow without needing to do other tests.

If your Doctor isn’t sure whether or not you have tennis elbow, they may arrange for you to have tests such as an X-ray, , CT scan or MRI scan. These give detailed images of your elbow joint and can help to find out what’s causing your symptoms.  

Treatment of tennis elbow

If you’ve tried resting your arm and taking painkillers but you still have symptoms after six weeks, your Doctor may suggest other treatment for tennis elbow. 

Medicines

Your doctor may suggest a steroid injection to help ease your pain if other treatments such as physiotherapy and painkillers haven’t worked. Steroids can be injected directly into the area where you have the most pain. These injections may help to reduce inflammation and ease your symptoms for a few weeks. But steroid injections are used less often now because they may not be very effective at easing your pain over the long term 

Physical therapies

Your Doctor may refer you to a physiotherapist to help you manage pain. A physiotherapist is a health professional who specialises in maintaining and improving movement and mobility. They may use various techniques including deep tissue massage, ultrasound therapy and taping. You may be given physiotherapy exercises to do to improve your strength and flexibility and ease your pain.

Other tennis elbow treatments

If self-help, medicines and physical therapies don’t seem to be working after six months or so, your Doctor may refer you to an orthopaedic consultant. This is a specialist in treating musculoskeletal problems, including conditions that affect the elbow. They will talk to you about other treatment options such as surgery and other types of injection. These are specialised treatments that are used only when other options haven’t worked.

Prevention of tennis elbow

You may be able to prevent tennis elbow by taking steps to protect your arm muscles and tendons. If your activities involve repeated arm and wrist movements, make sure you’re doing them the right way, taking breaks and using the right equipment. If you’ve had tennis elbow before and you want to prevent it from happening again, you may need to change some of the activities you do.

If you’re playing sport, particularly racquet sports, you might find it helpful to get a coach to make sure you’re using the right techniques.