Tennis elbow

At HCA UK we offer:

• Experts in tennis elbow and other forms of tendonitis
• Appointments with our shoulder and elbow consultants or our sport and exercise doctors confirmed within 24 hours
• Private orthopaedic care rated 'good' or 'excellent' (as rated by by 97% of our orthopaedic patients)

What is tennis elbow?

Tennis elbow, clinically known as lateral epicondylitis, is a common overuse or strain injury causing pain on the outside of the elbow. It's often confused with golfer's elbow, which refers to medial epicondylitis (on the inside of the joint).

The pain from tennis elbow usually stems from inflammation of the tendons that connect your forearm muscles to a bone structure at the base of your upper arm bone (humerus).

Although it is possible for the condition to heal naturally, repeated strain without treatment can worsen symptoms over time. The most serious cases result in microscopic tears of the tendon as overuse pulls fibres away from the bone, needing much longer and more drastic measures to recover.

Despite its name, you can develop tennis elbow from any activity where repetitive movement of the forearm fatigues the muscles and overloads the tendons around the joint. This is why people who play racket sports are more susceptible, just as professionals who rely on hand tools or repeat the same motions are as well.

What causes tennis elbow?

Tennis elbow isn't just a sports injury, as the name suggests. Lateral epicondylitis can develop in anyone repeatedly straining their forearm muscles or overloading them in sharp bursts.

Repetitive movements of your forearm can quickly fatigue its relatively small muscles. When this happens, the tendons connecting your muscles to the lateral epicondyle (the bony bump on the outside of your elbow) take more of the strain. If they become consistently overloaded, this can cause inflammation, pain and eventually tearing of the tendon.

Tendons are tough, cord-like tissues which move our limbs as the muscles they're connected to contract and relax. They're also important to absorb the various impacts and strains of movement. However, overloading tendons can strain the fibres and eventually tear them. Both medial and lateral epicondylitis are forms of tendonitis.

The tendon most likely responsible for tennis elbow symptoms is the one attached to the extensor carpi radialis brevis muscle, but any of the four muscles in the forearm could be affected by repetitive strain and lead to tendon damage.

Tennis elbow treatments

Living with lateral epicondylitis can make it more difficult and painful to carry out everyday tasks. It may even impact your ability to work and relax, so finding the best relief for tennis elbow is crucial.

The condition can get better on its own with enough rest. However, treatments may help to speed up the recovery process or heal the damage if it's not doing so naturally.

Non-surgical tennis elbow treatment

A shoulder and elbow consultant will first suggest non-surgical treatments for tennis elbow. These are often effective in the earlier stages of the condition and less severe cases.

• Avoid strenuous activities: It's best to take a break from the activities that caused your tennis elbow and any that continue to aggravate it. This will give tendons time to recover and prevent further damage. Hopefully, you'll be back out on the court or returning to work in no time.
• Rest, ice, compression and elevation: The RICE method is used to treat a range of musculoskeletal conditions. These steps should help to reduce inflammation of the tendons and promote healing.
• Over-the-counter medication: Painkillers such as paracetamol can help to relieve any pain and discomfort caused by tennis elbow and ibuprofen can reduce swelling to ease the pressure on your tendons and elbow joint. Ibuprofen may come in the form of tablets or topical creams and gels, depending on your preference.
• Elbow supports and braces: A dedicated strapping, brace or splint, called an orthosis, can be effective in compressing the elbow and supporting the joint to reduce any further strain on the surrounding tendons.
• Steroid or PRP injections: If treatments like the above haven't worked, some people are given injections of cortisone (steroids) or platelet rich plasma (PRP). Steroids reduce inflammation to promote healing, while PRP supports the body in repairing damaged tissue. These may need to be given with local anaesthetic.
• Shockwave therapy: This type of treatment involves high-energy shockwaves being sent through the skin to target damaged tissue. It can be effective in relieving pain and stimulating healing.

Surgical lateral epicondylitis treatment

If physiotherapy and other non-surgical treatments are unsuccessful in restoring pain-free movement to your joint, tennis elbow release may be recommended by your consultant.

The procedure can be done by elbow arthroscopy (a type of keyhole surgery) or open surgery to give the surgeon better access to the joint and surrounding tendons. Your consultant will discuss the type of anaesthetic you'll be placed under beforehand, with there being pros and cons to both local and general anaesthetic.

For elbow arthroscopy, you may only need local anaesthetic. This means you'll be awake during the surgery, but you won't feel any pain and you'll avoid the side-effects that can accompany general anaesthetic, such as nausea. 

Your surgeon will make small incisions on both sides of the elbow and insert a tiny surgical camera to allow them to assess the damage likely to be causing your pain and take the necessary steps, whether that be removing a bone spur or cutting and removing damaged muscles and tendons to promote healthy regrowth.

If open surgery is needed, a cut will be made on the outside of your elbow. Once the lateral epicondyle and the surrounding tendons have been exposed, the surgeon will assess the damage and make repairs or cut away any bone, tendon or muscle that is preventing healing.

Your consultant will discuss everything regarding the surgery in a pre-appointment meeting and can answer any questions you may have. Most tennis elbow release procedures are day cases, so no overnight stay required. However, arranging a pick up in advance to take you home after your surgery is advised.

Following your operation, you'll need several weeks to make a full recovery. Your consultant will outline any ongoing physiotherapy exercises to help restore your strength and movement.

Tennis elbow prevention

There are ways to prevent tennis elbow from developing or stop it reappearing after successful treatment, including:

• Improve form and technique: Whichever activity or movement is causing tennis elbow, your form and technique play a significant role in your chances of developing an injury. For sports-related conditions, a coach can help improve your form when it comes to the likes of tennis or squash. For work-related injuries, consider how you carry out your job and what steps you can take to protect yourself from strain.
• Strength and conditioning: Improved strength and endurance of your muscles ease the load put on tendons in times of fatigue. Consistent strength training and targeting of the forearm muscles should help prevent tennis elbow in the long term.
• Warm-ups and stretching: Overloading can happen in an instant, so warming up and stretching before any physical activity involving your forearm and elbow can help prevent straining and painful symptoms from emerging.
• Use the right equipment: Sports equipment, such as tennis rackets, should be the right size and type for your activity. The wrong size can strain certain parts of your arm and body in play, increasing the chances of tennis elbow.