What it is
Despite the name, you absolutely do not need to play tennis to develop tennis elbow. Tennis elbow — or lateral elbow tendinopathy — affects the common origin of the tendons that extend the wrist and fingers, where they attach to the outside of the elbow. It is extremely common and can develop following repetitive gripping, lifting, manual work, gym activity or sometimes for no obvious reason at all. Although it has traditionally been described as “inflammation”, persistent tennis elbow is better thought of as a tendon problem, with changes occurring within the tendon itself.
How it usually presents
- Pain felt directly over the outside of the elbow
- Pain when gripping something or lifting a kettle
- Pain opening a jar or carrying a bag with the palm facing down
- Symptoms that persist over months rather than settling quickly
What about a steroid injection?
Steroid injections can produce impressive short-term pain relief, but the longer-term evidence is much less favourable. Research has shown higher recurrence and poorer longer-term outcomes following corticosteroid injection compared with placebo. For this reason, current British Elbow & Shoulder Society (BESS) guidance strongly recommends that corticosteroid injections should not be used to treat lateral elbow tendinopathy.
How it is assessed
Usually clinical; ultrasound or MRI is used where the diagnosis is uncertain or symptoms are prolonged.
Treatment options
- Activity and load management alongside a structured physiotherapy programme
- Progressive loading: isometric, eccentric and concentric wrist-extensor strengthening
- Grip strengthening and gradual reintroduction of provoking activities
- Assessment of the neck and shoulder where symptoms are not settling
- Surgery only rarely, for symptoms resistant to prolonged appropriate rehabilitation
What does help?
Physiotherapy and progressive loading are the mainstay of treatment. Rather than completely resting the arm, rehabilitation gradually teaches the tendon to tolerate load again.
A programme may include gentle wrist-extensor stretching; isometric exercises, where the wrist works against resistance without moving; progressive resisted wrist extension; eccentric and concentric strengthening of the wrist extensors; grip strengthening; and gradual reintroduction of the activities that provoke symptoms.
Your physiotherapist can adjust the amount of resistance and number of repetitions as the tendon becomes stronger.
Tennis elbow often takes time to settle, but most patients do not require surgery. If directed physiotherapy is not working, it is important to consider causes of tennis elbow coming from the neck or shoulder which can be missed — rotator cuff dysfunction can cause symptoms that mimic tennis elbow.
For persistent symptoms despite a prolonged and appropriate rehabilitation programme, surgery can occasionally be considered. However, even surgery is not guaranteed to improve symptoms, which is why I would always discuss the potential benefits and limitations carefully before recommending an operation.
Non-surgical treatment is considered first wherever it is reasonable. Which option suits you depends on your symptoms, your goals and what you want from treatment, which is exactly what we discuss in clinic.
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