Tennis elbow

Symptoms of tennis elbow

Tennis elbow causes pain on the outside of the elbow. There may also be pain in the forearm spreading down as far as the back of the hand. The pain of tennis elbow can range from mild discomfort while using the elbow, to severe pain that can be felt even when the elbow is still. Repetitive wrist movements, such as extending the wrist and gripping, tend to make the pain worse.

If you have tennis elbow you will usually experience:

• pain on the outside of your upper forearm, just below your elbow – the pain may also travel down your forearm towards your wrist
• pain when lifting or bending your arm
• pain when writing or gripping small objects – for example, when holding a pen
• pain when twisting your forearm – for example, when turning a door handle or opening a jar
• pain and stiffness when fully extending your forearm

An episode of tennis elbow will usually last between six months and two years. Sometimes it does not settle down on its own, and can become chronic without treatment. For this reason, it is always wise to have tennis elbow treated as soon as possible.

What causes tennis elbow?

Tennis elbow is usually an overuse injury. It occurs when the muscles and tendons in your forearm are strained due to a repetitive or strenuous activity.

Tennis elbow can sometimes occur due to a specific injury, such as a bang on the side of the elbow. If the muscles and tendons in your forearm are strained, tiny tears can develop in the tendon where it inserts onto the bony prominence on the outside of your elbow.

You may get tennis elbow if your forearm muscles are not used to doing a certain activity, such as gardening or decorating. However, even if you use your forearm muscles frequently, you can still get tennis elbow.

Activities that can cause tennis elbow

You can develop tennis elbow by doing any form of activity that involves repetitive twisting of your wrist, and using your forearm muscles. Examples include:

• playing racquet sports, such as tennis, badminton or squash
• throwing sports, such as the javelin or discus 
• using shears while gardening
• using a paintbrush 
• plumbing or bricklaying
• activities that involve fine, repetitive hand and wrist movements, such as using scissors or typing 
• other activities that involve repeatedly bending the elbow, such as playing the violin

Despite its name, only 5% of people actually get tennis elbow from playing racquet sports.

When to seek treatment

If your elbow pain is caused by a strenuous or repetitive activity, you should avoid the activity until your symptoms improve. 

Get treatment if the pain in your elbow persists for longer than a few days, in spite of rest. Dr Allfree will examine you for swelling and tenderness, and do some simple tests to confirm the diagnosis, such as asking you to extend your fingers and bend your wrist backwards with your elbow extended. 

Treatment of tennis elbow

Tennis elbow can often last for several weeks or months because tendons heal very slowly. In some cases, tennis elbow can persist for a year or more.

A number of simple treatments can help alleviate the pain of tennis elbow. The most important thing you can do yourself is rest your injured arm and stop doing the activity that caused the problem.

Using an ice pack for a few minutes several times a day can help ease the pain. Purpose-made ice packs are available from The Mansfield Clinic.

Avoiding or modifying activities

If you have tennis elbow, you should stop doing activities that strain affected muscles and tendons. If you use your arms at work to carry out manual tasks you may need to avoid these activities until the pain in your arm improves. You may be able to modify the way you perform these types of movements so that they do not place strain on your arm. 

Painkillers and anti-inflammatories

Taking painkillers, such as paracetamol and ibuprofen, may help ease mild pain and inflammation caused by tennis elbow.

As well as tablets, anti-inflammatory medication is also available as a cream or gel. These are applied directly to a specific area of your body, such as your elbow and forearm. Topical anti-inflammatories are often recommended for musculoskeletal conditions, such as tennis elbow, rather than anti-inflammatory tablets, because they can reduce inflammation and pain without causing side effects, such as heartburn, nausea and diarrhoea.

Manual therapy

If your tennis elbow is causing you more severe or persistent pain then you will need to seek further treatment. At the Mansfield Clinic, Dr Allfree may use osteopathic techniques, such as massage and manipulation, to relieve pain and stiffness and encourage blood flow to your arm. He will also be able to show you exercises you can do to keep your arm mobile and strengthen your forearm muscles.

The use of an orthoses, such as a brace, may also be recommended in the short term.

Corticosteroid injections

Corticosteroid injections are sometimes used to treat particularly painful musculoskeletal problems. Corticosteroid injections may help reduce the pain of tennis elbow in the short term. The injection will be introduced directly into the painful area around your elbow. Before you have the injection, you may be given a local anaesthetic to numb the area to reduce the pain. Dr Allfree is very experienced in treating tennis elbow with steroid injections.

Autologous blood injections

Sometimes if steroid injections fail to give long term relief, Dr Allfree will use a technique called Autologous Blood Injection. Very simply, this involves obtaining a small amount of the patient’s blood, and re-injecting this around the injured tendon.

Shock wave therapy

Shock wave therapy is a non-invasive treatment where high-energy shockwaves are passed through the skin to help relieve pain and promote movement in the affected area.

How many sessions you will need depends on the severity of your pain. The National Institute for Health and Care Excellence (NICE) states that shock wave therapy is safe, although it can cause minor side effects including bruising and reddening of skin in the area being treated.

Research shows that shock wave therapy can help improve the pain of tennis elbow in some cases. However, it may not work in all cases and further research is needed. 

Surgery

Surgery may be recommended as a treatment of last resort in cases where tennis elbow is causing severe and persistent pain, and it has not responded to the treatments described above. The damaged part of the tendon will be removed to relieve the painful symptoms.

Preventing tennis elbow

It is not always easy to avoid getting tennis elbow, although not putting too much stress on the muscles and tendons surrounding your elbow will help prevent the condition getting worse. If your tennis elbow is caused by an activity that involves placing repeated strain on your elbow joint, such as tennis, changing your technique may alleviate the problem.

Listed below are some measures you can take to help prevent tennis elbow developing or recurring:

• If you have tennis elbow, stop doing the activity that is causing pain, or find an alternative way of doing it that does not place stress on your tendons.
• If you play a sport that involves repetitive movements, such as tennis or squash, get some coaching advice to help improve your technique.
• Before playing a sport that involves repetitive arm movements, warm up properly.
• Use lightweight tools or racquets and enlarge their grip size to help you avoid putting excess strain on your tendons.
• Wear a tennis elbow splint when you are using your arm, and take it off while you are resting or sleeping to help prevent further damage to your tendons. Ask Dr Allfree for advice about the best type of brace or splint for you to use.
• Increasing the strength of your forearm muscles can help prevent tennis elbow. Dr Allfree will be able to advise you about exercises you can do to build up your forearm muscles.