Tennis Elbow

What is tennis elbow?

Tennis elbow is a pain on the outer side of the elbow. In most cases the pain only occurs when you use the forearm, particularly on twisting movements such as turning a door handle. In some cases the pain is constant. About 5 in 1000 adults develop tennis elbow each year. It mainly occurs between the ages of 30 and 50.

What causes tennis elbow?

The site of the pain is where some tendons from the forearm muscles attach to the bone. The pain is thought to be due an injury, or several tiny injuries, to the tendon. The injury may cause a tiny tear to the tendon.

The injuries are usually caused by overuse of the forearm muscles in repeated actions such as wringing clothes, manual work, (particularly with twisting movements such as screwdriving). Playing tennis or other racquet sports can also cause it. It is more likely to develop if you use a lot of backhand play, or play with a lot of wrist action.

Tennis elbow is more likely to occur if you have unfit forearm muscles. For example, if you suddenly play a lot of tennis whilst on holiday, or you do a DIY project when you are not used to strong forearm actions. However, even if you are used to heavy work, you can overdo it and injure a tendon.

In some cases the condition develops for no apparent reason without any prior overuse or injury to the arm.

Not treating is an option
There is a good chance that symptoms will settle in time. It may take several weeks, or months, as tendons are 'slow healers'. One large study reported that in about half of cases the symptoms were either gone, or much improved, within four weeks. And within one year, symptoms were gone or much improved in more than 8 in 10 cases. Some people have symptoms for longer than a year though. So, one option is just to leave it and wait for symptoms to go. However, treatment may ease symptoms more quickly.

Anti-inflammatory painkillers
Anti-inflammatory painkillers such as ibuprofen are commonly used to ease pain. Some anti-inflammatory painkillers also come as creams or gels which you can rub over a painful elbow. Studies suggest that these may give better relief of pain for tennis elbow than tablets. There are various brands which you can buy, or get on prescription. Ask your pharmacist for advice.

Steroid Injection
An injection of a steroid into the painful area of the elbow often eases the pain. For some people, the pain never returns after having a steroid injection. However, for others, the relief from pain is only for a short time - perhaps for a few weeks. Also, it is worth bearing in mind the long term outlook before deciding on trying a steroid injection. A large research study looked at long term outlook. It compared those who had a steroid injection with those who did not. In this study, although about 9 in 10 of those who had a steroid injection had good short term pain relief, after one year only about 7 in 10 were free of pain. This compared to about 8 in 10 who were free of pain after one year who had not had a steroid injection.

So, in other words, a steroid injection may give good pain relief in the short term. But, it may increase your risk slightly of developing long term elbow pain compared to doing nothing and waiting for the pain to go on its own.

If you do have a steroid injection, the steroid is usually combined with a local anaesthetic to make the injection painless. When the local anaesthetic wears off the injection site may feel sore for a day or so.

Other treatment options

• Ordinary painkillers such as paracetamol may ease the pain until symptoms ease.
• In some cases, referral to a physiotherapist or to a specialist may be advised if symptoms persist or are severe. For example, a physiotherapist may advise that you wear an elbow armband or bandage may help to give support and protection to the elbow until symptoms ease. Another option may be to wear a wrist splints which may ease pain by helping to rest the muscles that pull on the elbow.
• If symptoms persist for more than several months, then a specialist may advise an operation. The common operation to ease symptoms is to remove the damaged part of the tendon. Only a small number of people require surgery to relieve symptoms.

Can tennis elbow be prevented?

You often cannot avoid a sudden overuse of the arm which can cause tennis elbow. However, if you increase the strength of your forearm muscles which bend the wrist backwards, it may help to prevent a further bout of tennis elbow in the future. The aim is to exercise and strengthen the muscles, but to avoid twisting movements.

It is best to see a physiotherapist for advice on how to strengthen your forearm muscles.

References

• Smidt N, Assendelft WJJ, van der Windt DAWM, et al. Corticosteroid injections for lateral epicondylitis: a systematic review. Pain 2002;96:23-40.
• Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006;333:939.
• Hay EM, Paterson SM, Lewis M et al. Tennis elbow. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. BMJ 1999;319:964-968
• Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003686

© EMIS and PIP 2007   Updated: February 2007

Advert