Tennis Elbow (Lateral Epicondylitis)

Tennis Elbow is a common condition characterised by pain over the outer aspect of the elbow and it is aggravated by force-exertion activities. It occurs most commonly in people of 35-50 years of age. Research shows that tennis elbow is a degeneration of soft tissue rather than an inflammatory condition only. It is also known as a common occupational repetitive stress injury (RSI).

Signs and symptoms 

Initially there may be swelling around the outer elbow, which is a sign of acute inflammation and it is particularly obvious after a sudden strain or trauma. Gradually, pain and weakness become more dominant due to the failure of soft tissue healing. The above symptoms occur while using the forearm and wrist, such as holding a knife or fork, twisting a towel or lifting a heavy object. For some people the pain can be constant and they may have pain and find it difficult to straighten their arm fully.

Common causes of tennis elbow 

• Sudden strain because of unusual activity, for example, suddenly playing a lot of tennis while on holiday 
• Poor elbow and wrist positions in activities, for example, poor ergonomics when using computers and keyboards 
• Lack of strength and flexibility of the forearm 
• Overuse of the elbow or repetitive micro-trauma, for example, frequent gripping and twisting 
• Racket sports with poor technique

Treatment options 

1. Anti-inflammatory and other painkillers  
   
   • Anti-inflammatory or painkillers such as ibuprofen are commonly used to ease the pain in tennis elbow. Some anti-inflammatory and painkillers also come as creams or gels which you can rub over the painful area. Please ask doctors or pharmacists for advice. 
2. Physiotherapy Management 
   
   • Advice on pain control and activity modification 
     
     • Rest, avoid lifting, gripping and twisting movements that can aggravate the pain 
     • Modify activities and avoid repetitive movements of the arm or hand, to reduce excessive stress on the muscles
     • If the tennis elbow has been brought on by playing sports, seek advice from a professional coach about techniques and racket grip size, etc.
   • Ice therapy
   • Manual therapy – mobilisations, massage etc.
   • Machine-based therapy – ultrasound, electrotherapy, etc. 
   • Exercise therapy – strengthening and stretching 
   • Use of tennis elbow band – reduce the loading to the muscles and tendons

*Appropriate treatment will be prescribed by registered physiotherapists after assessment

4. Steroid injections or Surgical treatment

If the above measures do not help, or if there is severe pain and difficulty using the arm, steroid injections may ease the pain. Every individual may react differently to the injection, the pain may not return for some people, but often, the pain relief effect may just be short term - around three months. Therefore, physiotherapy treatment after steroid injection is crucial to reinforce the treatment effect. 

If symptoms persist and remain unresolvable for over 6 months, specialists may advise surgical intervention. The common operation involves removing the damaged part of the tendon. However, few people require surgery.

How long does it take to recover from Tennis Elbow? 

As tendons take longer to heal, the pain from tennis elbow usually lasts for six to twelve weeks, however, the pain can last up to six months to two years in some people.