Tennis Elbow
Tennis elbow, also known as lateral epicondylitis or lateral elbow tendinopathy, is a common cause of pain on the outside of the elbow.
Despite the name, you do not need to play tennis to develop it. It commonly affects people whose work, sport or everyday activities involve repeated gripping, lifting, or use of the wrist and forearm.
What causes tennis elbow?
Several of the muscles that move the wrist and fingers share a common tendon attachment on the outside of the elbow, known as the common extensor tendon. In tennis elbow, changes develop within that tendon where it attaches to the bone. Persistent tennis elbow is usually a problem with the structure and capacity of the tendon rather than straightforward inflammation, which is why the older term lateral epicondylitis can be a little misleading.
Pain is typically felt directly over the outside of the elbow and may spread into the forearm. Gripping, lifting a kettle, carrying shopping, using tools, playing racquet sports or working at a computer can all become uncomfortable, and grip strength is often reduced.
Is all pain on the outside of the elbow tennis elbow?
No. Tennis elbow is very common, but several other conditions produce similar symptoms. Pain can arise from the elbow joint itself, from the radial nerve or the structures around it, and it can be referred from the neck.
That is why assessment matters, particularly where symptoms are unusual, where there is significant loss of elbow movement, where there are neurological symptoms, or where the elbow is simply not improving as expected.
Do I need an ultrasound scan?
Not everybody with tennis elbow needs a scan. In many cases the diagnosis is clear from the history and examination, and treatment can begin without imaging.
Diagnostic ultrasound is useful when symptoms have persisted, when the diagnosis is uncertain, or when a more significant tendon problem is suspected. It lets us examine the common extensor tendon and the structures around it, and can show changes in tendon structure, thickening, areas of degeneration, increased blood flow, or a partial tear.
Scan findings are read alongside the clinical examination, not on their own. Changes within a tendon can be present without being the main source of someone’s pain.
How is tennis elbow treated?
Physiotherapy and rehabilitation
For most people, rehabilitation is the starting point. The aim is to gradually restore the ability of the tendon and forearm muscles to tolerate load.
That usually means temporarily modifying the activities that aggravate it, progressive strengthening of the wrist and forearm, work on grip strength, and addressing anything else loading the elbow more than it can currently manage.
Complete rest is rarely the long-term answer. The aim is to find a manageable level of activity and build the tendon back towards normal work, sport and daily life.
Elbow supports and bracing
Some people find a tennis elbow strap or a wrist support helps during work or activity. These give temporary relief from symptoms and are used alongside rehabilitation rather than instead of it.
Where do injections fit?
Injections are not usually the first treatment for tennis elbow. A steroid injection, sometimes called a cortisone injection, can give short-term pain relief, but symptoms can return and repeated steroid injections around a tendon are generally avoided.
Where tendinopathy persists despite an appropriate rehabilitation programme, other ultrasound-guided treatment options may be considered after assessment. Which is appropriate depends on how long symptoms have been present, the clinical findings, the ultrasound appearances, and what has already been tried.
When is further investigation needed?
Most cases of tennis elbow need neither an MRI nor a surgical opinion.
Further investigation may be appropriate where there is significant loss of elbow movement, persistent unexplained pain, weakness, neurological symptoms, a history of significant trauma, or where the clinical and ultrasound findings do not adequately explain the symptoms. In those circumstances an X-ray, MRI or specialist opinion may be recommended.
Preventing tennis elbow if you play racquet sports
Tennis elbow is far from limited to tennis players, but if you do play, a few things reduce the load going through the tendon.
- Get your technique looked at. Faulty technique is a common cause, and the backhand is the usual culprit. A coach can assess your stroke.
- Watch your playing volume. Risk rises with sustained hours on court, so build up gradually rather than in jumps, and vary your training with off-court work.
- Check your equipment. Grip size, string tension and racquet weight all affect how much force reaches the elbow.
- Keep the forearm strong. Grip and wrist strengthening protects the tendon, and is the same work that treats the problem once it has started.
Much of this applies equally to badminton, squash and padel, and to work that involves repeated gripping.
Getting the diagnosis right
Persistent elbow pain is not always tennis elbow, and treating it as though it were is the most common reason an elbow fails to settle.
At Meyer Physio, assessment combines a detailed clinical examination with diagnostic ultrasound where that is likely to add useful information. The aim is to establish the most likely source of your symptoms, then decide whether rehabilitation, further imaging, an ultrasound-guided procedure or a specialist referral is the right next step.
Current fees for assessment, scans and injections are on our prices page.
Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175].