Tennis elbow (lateral epicondylitis)

    Published by Bupa's health information team, July 2009.

    This factsheet is for people who have tennis elbow, or who would like information about it. Tennis elbow is the common name for a painful condition affecting the outside part of the elbow. Tennis elbow is most common in people aged between 40 and 50. Depending on the severity it can take from two months to two years to heal fully.

    About tennis elbow

    The medical term for tennis elbow is lateral epicondylitis because it affects the outside of your elbow bone, which is called the lateral epicondyle. The lateral epicondyle is the bony area you can feel on the outside of your elbow. Tennis elbow develops when the tendon that joins the muscles of your forearm to your upper arm bone (the humerus) tears or becomes inflamed. This tendon is called the common extensor tendon (see diagram).

    Tennis elbow is a common condition that affects between one and three in 100 people.

    Tennis elbow most often happens when you have repeatedly overused your arm. This overuse causes inflammation or tiny tears in the tendon. This may become worse if you continue doing the activity that triggered the pain and may cause a more serious tear or rupture your tendon.

    Symptoms of tennis elbow

    The main symptom is pain and tenderness on the outside of your elbow and sometimes in the muscles on top of your forearm. Tennis elbow usually affects the arm of your dominant hand (eg your right arm if you're right handed) because this is the arm you use the most. Symptoms usually develop gradually. The pain may get worse when you move your wrist or if you repeat the activity that triggered the pain. The pain may become constant. Your affected arm may also be more painful when you grip or twist something, such as turning a door handle or shaking hands. If you have severe elbow pain, can't move the joint or have any loss of feeling, you should seek urgent medical attention.

    Many people with mild symptoms of tennis elbow can use self-help measures to reduce their pain. However, if your symptoms don't improve after a couple of weeks, you should visit your GP or physiotherapist for advice.

    Causes of tennis elbow

    The most common cause of tennis elbow is repeated overuse of your arm. Playing tennis three times in a week when you haven't played for some time is the sort of overuse that could cause tennis elbow. However, most people who develop tennis elbow haven't been playing tennis. A range of different activities that involve repeated hand, wrist and forearm movements is more often the cause. This includes activities like using a screwdriver, using vibratory work equipment (such as a drill), or even using a keyboard.

    Rarely, tendon damage can happen after a single and often minor incident, such as lifting something heavy or taking part in an activity which you don't do very often, such as painting and decorating. These activities can cause a tear in your tendon.

    Diagnosis of tennis elbow

    Your GP or physiotherapist will ask about your symptoms and examine you. He or she may also ask you about your medical history.

    Your GP or physiotherapist can usually diagnose tennis elbow from examining your arm and hearing about how your symptoms developed. An X-ray is rarely needed, but your GP/physiotherapist may recommend having one to rule out other conditions, such as arthritis, that can cause elbow pain.

    For severe tennis elbow that has failed to heal with normal treatment, your GP/physiotherapist might suggest a ultrasound scan. These give images of the soft tissues, including muscles and tendons, inside your arm.

    Treatment of tennis elbow

    To make a full recovery, you will need to change the way you use your arm so that your tendon is rested and has time to heal. How you do this will depend on how your tennis elbow developed and how severe it is.

    Self-help

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

    • Rest. The most important part of your treatment is to rest your injured tendon and elbow by stopping or changing the activity that is causing the problem.

    • Apply a cold compress to reduce your pain. You can use a cold compress, such as ice or a bag of frozen peas wrapped in a towel as soon as you feel any pain. Hold this against your elbow for 10 minutes every two hours. In the days that follow an injury you can use the ice pack for 10 minutes twice a day. Don't apply ice directly to your skin as it can damage your skin.

    • Wear strapping or a splint. You can wear strapping or a splint around your forearm and elbow to help restrict the movement of your tendon and relieve the strain. Some people find that this helps, although there is no evidence to show how well it works. You can buy arm braces and supports from some physiotherapists, larger pharmacies and sports shops. Don't wear any strapping or a splint continuously - you should leave it off at night time.

    • Change the action that caused the problem. If the problem developed as a result of an activity at work, contact your employer's occupational health advisers, if available, or speak with your employer. They can give advice on how to change the activity that caused the problem, allowing your arm to heal.

    Medicines

    You can take paracetamol to relieve the pain, and anti-inflammatory medicines, such as ibuprofen, to reduce inflammation. You can take ibuprofen in the form of a cream or gel that you put directly onto your skin, or you can take it 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.

    If paracetamol and ibupropen don't ease your pain, your GP may prescribe you a stronger painkiller called codeine.

    As a last resort, your doctor may also suggest a steroid injection to help relieve pain and inflammation if other treatments don't work, or if your pain is severe. This is an injection of steroid and local anaesthetic directly into the area where your pain is.

    Physical therapies

    Your GP will refer you to a physiotherapist if he or she thinks physiotherapy will be beneficial. Your physiotherapist may try various techniques to reduce the pain. These may include exercises, deep tissue massage and acupuncture.

    You may also be shown exercises to do that stretch your muscles and that can improve the movement and strength of your elbow and wrist. You should start these exercises as soon as possible after any injury, when your pain has eased. Your physiotherapist will be able to advise you on this.

    Surgery

    Your GP may advise you to have surgery if your tendon is severely damaged, or if there has been no improvement after many months of rest and rehabilitation. However, very few people need surgery.

    Prevention of tennis elbow

    Tennis elbow is usually caused by overuse of your arm, so it can be prevented. A few sensible precautions include:

    • warm up before activity with five minutes of gentle movements - this allows time for your muscles to adjust to the extra stresses and strains

    • try not to do the same activity for long periods of time - take regular breaks

    • seek advice early from your GP or physiotherapist if you notice a problem

    • stop the activity that's causing the problem or find a different way to do it.

    To prevent an old tennis elbow injury from coming back, you should:

    • give yourself proper rest between sessions

    • don't play sport if your arm is painful

    • get professional advice on your technique if you play racquet sports regularly

      perform exercises to strengthen the tendon in your arm, as advised by your physiotherapist