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Tennis elbow

Tennis elbow can create pain and weakness in the elbow tendons. We look at its common symptoms and how it can be treated.

Tennis-player-elbow-taped
Tennis elbow (extensor tendinopathy) is a condition that causes pain and weakness in the tendons in the elbow which attach the muscles of the forearm with the outer elbow bone (lateral epicondyle). It is often associated with increased periods of unaccustomed strenuous activity with the forearm muscles.

Common examples may be an increase in computer use (especially if there is a poor ergonomic setup), DIY tasks involving gripping and twisting with the wrist/ hand and sometimes racket sports. Although rackets sports players can develop a common extensor tendinopathy, the majority of individuals who develop symptoms do so because of prolonged, repetitive activities including warehouse or desk-based work, often with a poor ergonomic setup.

Localised pain is felt directly over the common extensor tendon in the outer elbow which sometimes radiates down the forearm muscle bulk.

Symptoms are aggravated by any activity which requires repeated use of the wrist extensor muscles. Common examples may include working at a computer (keyboard or mouse work) or gripping, lifting, or carrying tasks.

When you meet with your doctor, they will discuss your elbow pain in depth. This will help them reach an accurate diagnosis. They might ask:

  • Does your pain have an obvious cause or trigger, or did it appear without warning?
  • Have you ever had a similar type of pain in your elbow?
  • Have you had a previous injury to your elbow?
  • Do you have any other symptoms (even if they’re seemingly unrelated to your elbow pain)?

Depending on your symptoms, other diagnostic tests might be used to rule out other causes of your elbow pain. These tests include an elbow X-Ray, an ultrasound or an MRI. Your doctor will explain these tests to you if they are needed.

We treat patients of all ages and all backgrounds, ranging from elite sportspeople to those who want to improve their day-to-day quality of life. We have an expert team on site to support your treatment, including physiotherapists, sports and exercise consultants, radiologists, neurologists and more, to make sure your recovery is as fast, effective and convenient as possible.

If you are coming to us directly (rather than via GP or insurance referral), we offer very competitively priced self-pay packages, along with payment plan options to help make private healthcare accessible and affordable for all.

There are several different ways a tennis elbow can be treated.

Pain relief

Painkillers might help manage your pain. Paracetamol or an anti-inflammatory medicine like ibuprofen often reduces pain, helping to improve your mobility.

Heat therapy

A heating pad could help relax your joints, improving your mobility and reducing pain. Alternatively, placing a cold compress on your elbow throughout the day could numb your elbow, reducing pain and providing relief.

Steroid injections

Steroids can reduce inflammation, so injecting this medicine into the affected area may ease your symptoms. You might be given a local anaesthetic for the procedure.

The relief offered by steroid injections is temporary, so you will likely have to have them every few months.

Tennis elbow exercises

According to the National Institute of Health Research, physiotherapy services are an important way to prevent and reduce the negative impacts of musculoskeletal conditions, improving patients’ lives.

Circle Health Group physiotherapists can work with you to create a programme of exercises that will help your elbow to get back to normal. Starting off gently, these physical therapies will help to build strength and restore motion to your arm.

Your physical therapist will recommend strengthening exercises for you to do several times a day. It is important to follow your exercise regime diligently to reap its benefits. Learn more about physiotherapy and elbow pain exercises here.

Tennis elbow brace

if you are continuing to use your affected arm, you may need to wear a brace. A compression strap can help to minimise tension and ease stress on the affected elbow.

Extracorporeal shockwave therapy (ESWT)

Extracorporeal shockwave therapy (ESWT) involves the use of a medical device to pass shockwaves through the skin to the injured part of the body.

A course of ESWT usually requires three to four sessions, each taking about 30 minutes, which in addition to the ESWT, includes advice on retraining weak muscles related to the injury.

ESWT is carried out at an outpatient appointment and requires no injections, medication or surgery.

Tennis elbow surgery

If you have tried other treatments across several months and are still in significant pain, your Consultant might recommend elbow surgery.

During the operation, your surgeon will remove any damaged tendons from your elbow. This should take around half an hour, and you should be able to get back to your regular activities within a few weeks, depending on how the elbow heals.

Your consultant will examine the elbow and may use imaging technology to view the joint and rule out other causes of pain. You may be prescribed medication to treat the pain and inflammation. You will be required to rest your elbow and abstain from sports or heavy activities for a short time, and you may have to wear a splint to support your elbow.

You may be required to attend physiotherapy sessions which is often a highly effective and evidenced based treatment for tennis elbow. Exercises involve gradually strengthening exercises for the forearm muscles which gradually increase the amount of load, thereby strengthening the affected tendon.

In some cases, an operation will be required to release the inflamed tendon, debride it and repair where necessary.

Shoulder and elbow surgery can result in considerable pain and discomfort after the operation. Traditional painkillers are not always effective and have side effects. We usually offer you a local anaesthetic “block” to reduce the pain and discomfort following the procedure and allow early more comfortable physiotherapy (if required). This consists of an injection at the side of your neck onto the nerves that supply your shoulder. The injection itself is fairly painless.

Depending on the treatment required you should be able to return home the same day, but your recovery time is dependent on the severity of the injury. Your consultant will advise you and answer any questions you may have.

If a surgical release is considered, this is a generally safe procedure but there are some potential complications you should be aware of. These affect a very small percentage of patients.

  • Infection can occur although our theatres have ultra-clean air operating conditions keeping infection rates to the minimum.
  • Blood clots are possible after any operation and are more common in patients with some pre-existing medical conditions. However, again they affect a very small percentage of patients and have well established treatments including aspirin.
  • Very rarely, damage to the nerves around the elbow leading to numbness, pain and in some cases weakness in the hand - this usually settles on its own.
  • There may be continued pain in the elbow following the surgical release.

Specialists offering Tennis elbow

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Mr Nick Aresti

Consultant Trauma & Orthopaedic Surgeon

MBBS BSc (Hons) FHEA FRCS (Tr&Orth)

The Kings Oak Hospital

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Mr Scott Barker

Consultant Trauma and Orthopaedic Surgeon

MB ChB, FRCSEd(Tr & Orth)

Albyn Hospital

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Mr Nitin Modi

Consultant Orthopaedic Surgeon

MBBS, MS Orthopaedics FRCS (T&O), MS Orthopaedics, MRCS, FCPS Orthopaedics, Diploma Orthopaedics

St Edmunds Hospital

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Mr Simond Jagernauth

Consultant Upper Limb Orthopaedic Surgeon

MBBS BSc (Hons) FRCS (Tr & Orth) (Eng)

The Cavell Hospital 1 more The Kings Oak Hospital

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Mr Barnes Morgan

Consultant Orthopaedic Surgeon

MBBS, BSc, MSc, FRCS (Tr & Orth)

The Alexandra Hospital

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