Tennis elbow

Tennis elbow causes pain around the outside of the elbow. Despite its name, racquet sports such as tennis are the cause in only a tiny number of cases, and it's often caused by work related injury or actions that involve gripping and twisting of the forearm.

In most cases, the condition will resolve itself within two weeks, but it can become a more persistent problem lasting between six months and two years and is likely to recur.

Causes

Tennis elbow is caused by a strain to tendons – tough cords of tissue that connect muscle to bone – and muscles in the forearm. It develops when the tendon that joins the bony lump (lateral epicondyle) on the outside of the elbow becomes inflamed or has micro-tears.

Tennis elbow can occur as a result of any activity that involves gripping and twisting your wrist repeatedly and using forearm muscles, including: using a racquet; shears while gardening; manual work, for example, bricklaying; and activities that require repetitive hand and wrist movements, such as knitting.

It can also flare up after you knock yourself or bump into something accidentally.

Symptoms

Symptoms can range from a mild twinge when you move your arm, to severe pain when still or asleep. The most common symptom of tennis elbow is pain and tenderness on the outside of your elbow and the muscles in your forearm.

Your elbow may also feel stiff and ache when it’s fully extended and when lifting or bending your arm, writing, gripping small objects and twisting your forearm.

Diagnosis

If your symptoms get worse despite resting your elbow and using over the counter painkillers, see your GP, who will check for swelling and tenderness, and carry out some simple tests to gauge how much your elbow and forearm are affected.

Further tests aren’t generally needed, though if your GP suspects nerve damage, you may be referred for an ultrasound or a magnetic resonance imaging (MRI) scan.

Who gets tennis elbow?

Between one and three people in 100 have tennis elbow, though it is more common as you get older, affecting one in five people aged 30 to 60.

Tennis elbow affects men and women equally and the peak age group for people developing it is between 40 and 50.

People who do jobs involving repetitive extension of the wrist, such as plumbers, and others which use grip intensive activities, such as chefs and carpenters, may be particularly at risk. A study published by the Iowa Orthopaedic Journal found that tennis elbow was much more common in ex-smokers.

Treatments

Avoiding activities that are causing you pain, or minimising them as much as possible, should help. Your GP may give you some gentle exercises to relieve pain and strengthen your muscles and tendons.

To relieve pain, hold a cold or warm compress against your elbow for a few minutes several times a day. Painkillers, such as paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help ease pain and reduce inflammation in the short-term. NSAIDs are also available as a cream or a gel and are often recommended over tablets.

If the pain is severe and/or persistant, you may need physiotherapy. Massage and laser therapy techniques (where laser energy is used over the affected area); and ultrasound therapy, which uses sound waves to treat muscle spasms and pain, can be useful. You may also be advised to wear a splint, strap or brace to support your elbow.

To ease pain and promote movement, shockwave therapy, where high-energy shock waves are passed through the skin to the affected areas, may also be an option.

If the pain is severe your GP may recommend a corticosteroid injection for short-term pain relief.

Surgery to remove the damaged part of the tendon may be suggested if none of the above treatments work.

Nothing beats a healthy, balanced diet to provide all the nutrients we need. But when this isn’t possible supplements can help. This article isn’t intended to replace medical advice. Please consult your healthcare professional before trying supplements or herbal medicines.

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