Tennis Elbow: what it is and how to treat

27th June 2022

Written by: Dr. Vicann During, Sports & MSK Physician

The summer is a great time to be outdoors and physically active with the longer and warmer days. In the spirit of the Wimbledon Tennis Championships we thought it would be useful to talk about an issue that we see commonly.

What is tennis elbow?

Tennis elbow is an issue affecting tendons which attach to the outside of your elbow. As the name suggests, it is an issue seen in those playing tennis, though the problem is regularly seen in other sports and (perhaps most commonly) is seen in people that do not play sport at all. It is often thought of as due to repetitive (over)use of the tendon, though it often is caused by the doing activity that you are unaccustomed to nor infrequently. It can sometimes be linked to other health problems like diabetes.

How do I know if I have it?

The main feature of tennis elbow is pain around the outside of the elbow. This may be caused in tennis by performing a backhand stroke. Other activities that may cause pain include gripping items like weights in the gym or shopping bags from the floor or rotating your forearm like using keys or using door handles and knobs. The pain can sometimes spread from the elbow down to the forearm and you can at times see swelling in the elbow. Milder cases may only cause discomfort during activity and do not limit you whilst more severe cases may stop you from doing the painful activities, no matter how simple the task may be.

How is it treated?

Most of the time the problem settles down with simple rest and avoiding aggravating activities. Using a wrist support when doing painful activities or overnight may also help in the early stages of pain. Input from a Physiotherapist with exercises can be particularly effective, although exercises can take up to 12 weeks before you notice a benefit.

Why should I see you if it gets better by itself?

There will always be occasions where the pain does not get better by itself, even with input from a Physiotherapist, or the pain is too severe to fully carry out any exercises recommended and is severely impacting on your life. In these cases, it is vital that a scan is done. Ultrasound scanning, which can be done by Dr. Vicann During in clinic during your appointment, is an effective way of looking at the health of the tendons to help ensure that the correct diagnosis has been made.

If the diagnosis has been confirmed following a scan, medication options can be discussed and prescribed by Dr During. Treatments like shockwave can be also be effective. Procedures done under ultrasound guidance can also be done by Dr During if indicated, such as tenotomy (using a needle to repeatedly pierce the tendon to cause inflammation and stimulate the body to repair the tendon). Ultrasound guided injections such as with cortisone steroid have fallen out of favour as in the long term patients may do worse compared to if they never had the injection, though on specific occasions it can still be used and done in clinic. These treatments though should be done alongside exercises to maximise the chance of long term recovery.

Do I need surgery?

Surgery is very rarely required for this problem and the vast majority of people do usually get better one way or another. The decision to consider surgery should usually only be made in cases where the diagnosis has been confirmed on imaging and all of the above treatment options have been trialled (unless there is a clear reason not to) without any benefit.

Final comments

Fortunately, the majority of people who suffer with tennis elbow will get better without ever needing to have a scan and medical intervention. However if you are struggling with your pain or are not clear on exactly what your problem is, booking an appointment with Dr During to review and scan your elbow is the best way to get a proper diagnosis and management plan to hopefully get you pain free!

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