Tennis elbow

Tennis elbow is a chronic degenerative condition of a tendon on the outside of the elbow. It is also known as ‘lateral epicondylitis’ .  It is not an inflammatory condition.


Tennis elbow is caused by an imbalance in the normal tissue turn-over in the extensor tendons that arise from the lateral epicondyle on the outer side of the elbow.    Extensor Carpi Radialis (ECRB) tendon is most commonly affected, and it is usually precipitated by repetitive strain. This tendon is involved in extending the wrist joint and is also active when gripping with the wrist extended (as in tennis). Any activity that twists and extends the wrist can lead to tennis elbow.

Tennis elbow is a continuum from reactive change, through tendon disrepair to development of a degenerative tendon.  It is important to determine where the individual is on this continuum to guide treatment. (Cook and Purdham)


The first sign of tennis elbow is usually tenderness and pain when pressure is applied to the outside of the elbow. If left untreated, a dull constant pain or sharp shooting pain can be felt. Swelling may be present. Other symptoms include:

  • Pain when the wrist or hand is straightened (wrist extension)
  • Pain felt when lifting a heavy object
  • Pain when making a fist or shaking hands
  • Shooting pains from the elbow down to the forearm or up into the upper arm

Pain with tennis elbow is typically localised over the bony bump on the outside of the elbow (lateral epicondyle) and may extend down to the hand. This area is usually very tender to touch. Rest usually relieves the pain.
Sometimes other conditions that are not linked to tennis elbow can cause pain in the elbow. For example, arthritis of the elbow, a pinched nerve in the neck, shoulder impingement and carpal tunnel syndrome.


The type and duration of the treatment will depend on the severity of the condition. The first step in treating tennis elbow is to manage the activities that cause the pain, such as tennis or golf.

  • Pain killers medications relieve the pain.
  • A tennis elbow strap can be worn just below the elbow to limit the stress on the ECRB tendon.
  • Treating the area with an ice pack and performing an ice massage are also recommended.
  • Physiotherapy to stretch the tendon and retrain the extensor muscles is important. Eccentricexercise programmes are popular and prove effective in 70% of cases.


If the condition does not respond to the above treatments, injections are often used. Steroid injections are the most commonly used injections, but they generally wear off after a few months. There is some evidence that while steroid injections may provide short term relief they make make the condition go on for a longer period.  More recently Platelet Rich Plasma (PRP) injections have shown to be more effective than steroid injections, but are more expensive.


For very severe cases and those that fail to improve after injections surgery may be necessary. The surgery is usually performed as day case surgery. This may be performed by an open approach, percutaneous or arthroscopically (keyhole). There are pros and cons to each of these methods, but the results are similar.

You will be able to start moving your elbow normally two days after the surgery, with 1 week off work. Full recovery may take three months.


To prevent tennis elbow from reoccurring, it is important to make sure you keep the muscles strong by exercise and using the proper form whether playing tennis or lifting heavy objects. Warming up before starting to use the muscle will also help prevent the condition. After exercising, you may want to ice and stretch the elbow and arm muscles.

Do you want to read more?

Professor Watts has presented the findings of a randomised controlled trial performed at Wrightington Hospital comparing the outcome of PRP injection against surgery for tennis elbow.  Surgery had a higher success rate but 7 out of ten patients who had PRP injection avoided the need for an operation.

To see the presentation click here