What is tennis elbow?

Tennis elbow is a type of tendonitis that causes pain around the outside of your elbow. It's also known as lateral epicondylitis.  It most commonly occurs in non-tennis players, but is named ‘tennis elbow’ due to the first report of the condition in lawn tennis players. The condition is caused by overuse of the muscles and tendons in your forearm near to your elbow joint, and can occur as a result of any activity that involves repetitive movement in your elbow, wrist and forearm. It can impact anyone, but is most common in people aged 30 to 50 years. Although movement of your elbow joint isn’t restricted, it can be painful and make some everyday tasks difficult.

What causes the condition?

Around your elbow joints are muscles that move your elbow, wrist and fingers. Tendons connect some of these muscles to the bony lump on the outside of your elbow. When your muscles and tendons are overloaded, tiny tears can form causing a thickening of the tendon. Over time, this can become painful.

Activities which may cause tennis elbow include:

• Decorating
• Playing tennis
• Playing a musical instrument
• Repeated use of a computer mouse.
• A similar condition causing pain on the inside of the elbow is golfer’s elbow.

What are the typical signs?

The key symptoms of tennis elbow is pain that:

• Can spread to your forearm, wrist and fingers
• Gradually increases over time
• May get worse when you use the muscles to do simple tasks like using a knife or fork, hold a cup or straighten your arm fully
• Is felt when you push your middle finger backwards.

Tennis elbow usually affects one arm more than the other (usually the dominant arm) and you may experience crepitus (a creaking sensation).

How is it diagnosed and treated?

Diagnosis

Your consultant will discuss your symptoms with you and perform a medical examination, for example, to see if you have pain when you stretch out your fingers and flex your wrist while your elbow is extended. This may be followed by an MRI or ultrasound scan to rule out other conditions.

Treatment

Non-surgical treatment: Modifying activities to avoid those that make your symptoms worse is simple but very effective. Painkilling tablets and application of ice packs over the area can ease the symptoms. A clasp brace is useful in some patients and you will be assessed for this by your consultant. Injections into the painful area have also been shown to be effective. Physiotherapy has a key role in all patients with tennis elbow.

Steroid injections are now only rarely used in the management of tennis elbow. Injection therapy in the form of Platelet Rich Plasma is more commonly now used & involves a concentration of healing factors extracted & concentrated from a sample of your own blood, re-injected to stimulate healing of the affected tendon.

Surgery: An operation will only be considered by your consultant if all other measures have failed. Approximately 75 to 80% of patients will get better with treatments not requiring surgery. If you have a procedure, this is performed as a day-case (you will come into hospital on the morning of surgery and go home on the same day). Either keyhole (arthroscopic) or open procedures are used, and the pros and cons of these will be discussed in detail with you during your consultation.

Recovery

This depends on the type of treatment you’ve had, but can take approximately eight weeks, if you’ve had surgery. Your consultant will be able to advise you on this.

When can I return to normal activities?

• Work - this depends on your individual employment and lifestyle, however if your job mainly involves sitting then an approximate guide is around four to six weeks post-surgery. If you have a more active role, your consultant will be able to advise you on a suitable period of time, however it could take up to four months
• Driving – You can anticipate returning to driving by six weeks following surgical release
• Exercise – Light exercise can resume as soon as your surgical incision has healed (two weeks), although usually heavier lifting is restricted until eight weeks post-surgery.