Taking a swing at tennis elbow

Tennis elbow, medically known as lateral epicondylitis, is a common condition that causes pain around the outside of the elbow. Despite its name, it doesn’t just affect tennis players. In fact, the majority of people who develop tennis elbow do not play racket sports at all.

In this article, a consultant orthopaedic surgeon explains what causes tennis elbow, and what patients can do to treat and prevent it.

What is tennis elbow?

Tennis elbow is caused by overuse or repetitive strain of the muscles and tendons in the forearm that attach to the outer part of the elbow. The affected tendons are responsible for extending the wrist and fingers, and repeated stress leads to small tears and inflammation where the tendons anchor to the bone.

While it can be caused by playing tennis or other racket sports, it is more commonly seen in people whose work or hobbies involve repetitive arm or wrist movements. This includes manual labourers, painters, gardeners, or those who use hand tools frequently. Even office workers who use a computer mouse excessively or with poor ergonomics may be at risk.

Symptoms of tennis elbow

The main symptom of tennis elbow is pain on the outside of the elbow, which may gradually worsen over time. This pain can:

Radiate down the forearm towards the wrist
Worsen when gripping, lifting or twisting objects
Be particularly noticeable when shaking hands or turning a doorknob
Lead to reduced grip strength

In some cases, the elbow may feel stiff or tender to touch, and activities such as lifting a kettle or opening a jar can become difficult.

Risks of tennis elbow

While tennis elbow is not a dangerous condition, ignoring it can lead to prolonged pain and disability. If left untreated, it can become chronic, lasting several months or even years. This may interfere with work, sports, and everyday tasks.

Ongoing inflammation and strain may also result in further degeneration of the tendon, making it harder to treat successfully in the long term. In some cases, compensatory movements may lead to pain in the shoulder, neck or wrist, as the body attempts to offload the injured area.

Early recognition and appropriate management are key to preventing these complications.

Treatment for tennis elbow

Most cases of tennis elbow can be managed successfully with non-surgical treatment, especially if addressed early. These may include:

Rest and activity modification: avoiding or adjusting tasks that aggravate the condition
Physiotherapy: targeted stretching and strengthening exercises to improve flexibility and load tolerance
Pain relief: such as anti-inflammatory medication or cold packs to reduce discomfort
Bracing or strapping: forearm supports can help offload the affected tendon during activities

In more persistent cases, further treatment may be required:

Steroid injections: may offer short-term relief, although repeated use is not recommended
Shockwave therapy: uses sound waves to stimulate healing in the tendon
Platelet-rich plasma (PRP) injections: a newer treatment using components from the patient’s own blood to promote tendon repair

If symptoms continue despite comprehensive non-surgical management, surgical intervention may be considered. This involves removing damaged tendon tissue and reattaching healthy tendon to the bone, usually as a day case procedure.

How to prevent tennis elbow

Prevention is largely about reducing repetitive strain and maintaining healthy tendon function. Steps that can help include:

Using proper technique and equipment when playing sports or performing physical work
Taking regular breaks during repetitive tasks
Strengthening forearm muscles through exercise to improve resilience
Ensuring proper posture and ergonomics, particularly at workstations
Warming up before physical activity and avoiding sudden increases in intensity

Awareness and early action are key. At the first signs of discomfort, it’s important to reduce aggravating activity and seek advice before the problem becomes more severe.