Sports injuries
Tennis Elbow (Lateral Epicondylitis): Symptoms and Treatment
In short
Tennis elbow (lateral epicondylitis) is pain on the outer side of the elbow caused by overuse strain of the tendon that attaches the wrist-lifting muscles to the bony bump on the outside of the elbow, and it is common in people who never play tennis. Most people get better with non-surgical care such as rest, activity changes, exercises and a forearm strap, although symptoms can sometimes last more than a year. Surgery is considered for the small number of people who do not improve after 6–12 months of appropriate treatment.
What is tennis elbow?
The forearm muscles that lift the wrist and fingers attach by a tendon to the bony bump on the outer side of the elbow (the lateral epicondyle). In tennis elbow, the tendon most often affected belongs to one of these muscles, the extensor carpi radialis brevis [2].
Repeated strain causes tiny tears where the tendon attaches to the bone, leading to pain and tenderness. Despite the name, most people with the condition do not play tennis [1][2].
Symptoms
Pain usually starts gradually and builds over weeks or months. It can range from mild discomfort to constant pain that disturbs sleep [1][2]. Common symptoms include:
Causes and risk factors
The cause is activity that involves repeated gripping and twisting of the wrist. Examples include long hours using a computer mouse, sewing, using screwdrivers or paintbrushes, and racket sports [1][2].
People in hand-intensive jobs, such as painters, plumbers and carpenters, are affected more often. The condition is most common between the ages of about 30 and the mid-50s [1][2].
Diagnosis
Diagnosis is usually made from the history and examination. The doctor checks for tenderness over the outer elbow and whether lifting the wrist against resistance causes pain [2].
Scans are not always needed. An X-ray may be used to rule out other causes such as arthritis, an MRI to show the extent of tendon damage, and a nerve test (EMG) to rule out a trapped nerve [2].
Treatment without surgery
The first step is to avoid the movements that make the pain worse for a while. Paracetamol or an anti-inflammatory gel, hot or cold packs for up to 20 minutes a few times a day, and a forearm strap from a pharmacy can help [1].
If there is no improvement after 6 weeks of home treatment, physiotherapy is advised. It may include massage and stretching and strengthening exercises for the wrist and forearm [1]. According to a Cochrane review, manual therapy and exercise may slightly reduce pain and disability at the end of treatment, but evidence that the benefit lasts is weak [4].
A steroid (cortisone) injection can ease pain quickly in the short term. However, in a randomised trial, people who had a steroid injection did worse at one year than those who had a placebo injection, and symptoms came back more often [3]. The pros and cons of a steroid injection should therefore be discussed carefully with the doctor.
Platelet-rich plasma (PRP) and injections of the patient's own blood are also used [2]. However, a Cochrane review found that these injections give no meaningful benefit for pain or function compared with a placebo injection [5]. Most people improve with non-surgical treatment [2].
Surgical treatment
Surgery may be considered if symptoms have not improved after 6–12 months of appropriate non-surgical treatment [1][2].
During the operation, the damaged tendon tissue is removed and healthy tissue is reattached to the bone. It can be done as open surgery or arthroscopically (keyhole) [2].
Recovery
Tennis elbow often settles after a few weeks of rest, but in some people symptoms can last more than a year. Patience and sticking with the treatment plan are important [1].
After surgery the arm is protected in a splint for a short time, then movement exercises begin. Strengthening exercises are added at around two months, and return to sport is usually possible 4–6 months after the operation [2].
When to see a doctor urgently
Tennis elbow is not an emergency. See a doctor if pain lasts longer than 2 weeks despite home care [1]. Go to an emergency department straight away if [6]:
- You have severe arm pain and the arm is difficult to move
- You heard a snap when you injured the arm, or the arm has changed shape
- The arm tingles or feels numb
- The arm is swollen and you have a high temperature or feel shivery
- Arm pain starts suddenly together with pressure, heaviness or tightness across the chest: this can be a heart attack, so call emergency services (112) immediately
Frequently asked questions
+How long does tennis elbow take to heal?
Most people improve with a few weeks of rest and activity changes. In some people, however, symptoms can last more than a year [1].
+Should I have a steroid injection for tennis elbow?
A steroid injection may bring quick short-term relief, but one-year results were worse than with a placebo injection and symptoms returned more often. The decision should be made with the doctor after discussing the pros and cons [3].
+Does PRP work for tennis elbow?
A Cochrane review found that PRP and injections of the patient's own blood give no meaningful benefit for pain or function compared with a placebo injection [5].
Sources
- [1]Tennis elbow — NHS (nhs.uk), 2024.
- [2]Tennis Elbow (Lateral Epicondylitis) — American Academy of Orthopaedic Surgeons (OrthoInfo).
- [3]Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial (Coombes BK, et al.) — JAMA, 2013.
- [4]Manual therapy and exercise for lateral elbow pain (Wallis JA, et al.) — Cochrane Database of Systematic Reviews, 2024.
- [5]Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain (Karjalainen TV, et al.) — Cochrane Database of Systematic Reviews, 2021.
- [6]Elbow and arm pain — NHS (nhs.uk), 2024.
This article is general information and does not replace an examination or personal medical advice. In an emergency, go to the nearest emergency department.