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Tennis elbow

You don't have to be a tennis player to be affected by tennis elbow, an overuse injury causing pain around the outside of the elbow.

Tennis elbow, also known as lateral epicondylitis, is believed to affect around one in three people at any time, most often between the ages of 40 and 60.

Tennis elbow most commonly affects people in their dominant arm (that is, a right-handed person would experience pain in the right arm), but it can also occur in the non-dominant arm or both arms.

What are the symptoms of tennis elbow?

Symptoms of tennis elbow include:

  • Pain slowly increasing around the outside of the elbow. Less often, pain may develop suddenly.
  • Pain is worse when shaking hands or squeezing objects.
  • Pain is made worse by stabilising or moving the wrist with force. Examples include lifting, using tools, opening jars, or even handling simple utensils such as a toothbrush or knife and fork.

Who gets tennis elbow?

Although tennis elbow commonly affects tennis players, it also affects other athletes and people who participate in leisure or work activities that require repetitive arm, elbow and wrist movement. 

Tennis elbow might result from:

  • Tennis
  • Squash
  • Fencing

There have been reports of tennis elbow type injuries from playing active video games, such as the Wii, PlayStation and Xbox.

It can also affect people with jobs or hobbies that require repetitive arm movements or gripping such as:

  • Carpentry
  • Typing
  • Painting
  • Raking
  • Knitting
  • Cleaning
  • Road workers
  • Chefs and waiters.

How is tennis elbow diagnosed?

Tennis elbow cannot be diagnosed from blood tests and rarely by X-rays. Rather it is usually diagnosed by the description of pain you provide to your doctor and certain findings from a physical examination.

Your doctor may ask you to flex your arm, wrist and elbow to see where it hurts.  If your GP refers you to a clinic, such as a rheumatology or a specialist physiotherapy clinic then you may also need imaging tests, such as an X-ray or MRI (magnetic resonance imaging) to rule out other problems.

Since many other conditions can cause pain around the elbow, it is important that you seek medical advice so the correct diagnosis can be made. Then your doctor can recommend the appropriate treatment.

Tennis elbow usually is successfully treated by medical means and only rarely requires surgery.

The type of treatment recommended for tennis elbow will depend on several factors including age, type of other medications being taken, overall health, medical history and severity of pain. The goals of treatment are to reduce pain or inflammation, promote healing and decrease stress and abuse of the injured elbow, and allow full use of the arm.

Treatment for tennis elbow

The good news about treatment is that usually tennis elbow will heal on its own. You just need to give your elbow a rest and do what you can to speed up the healing. Types of treatment that help are:

  • Icing the elbow to reduce pain and swelling. Applying ice directly to the skin can cause burns just like heat can so take care to wrap the ice well in a towel first. Experts recommend doing this for 20-30 minutes every three to four hours, for two to three days, or until the pain is gone.
  • Using an elbow strap to protect the injured tendon from further strain.
  • Taking painkillers such as paracetamol or nonsteroidal anti-inflammatory drugs ( NSAIDs) such as ibuprofen and aspirin to help with pain and swelling. However, NASIDs can cause side effects such as stomach irritation so you should only use them as short courses, guided by your GP or specialist.   
  • Performing range of movement exercises to reduce stiffness and increase flexibility. Your doctor may recommend that you do these three to five times a day.
  • Having physiotherapy to strengthen and stretch the muscles.
  • Having injections of steroids or painkillers to temporarily ease some of the swelling and pain around the joint.
  • Shock wave therapy to help promote movement and relieve pain may sometimes be recommended.
  • Other therapies: acupuncture may help to relieve the pain.

Most of the time, these treatments will do the trick. But if you have a severe case of tennis elbow that doesn't respond to treatment within two to four months, you may need surgery. With surgery, the damaged section of tendon usually is released and the remaining tendon may be repaired. Occasionally people with tennis elbow eventually need this treatment. Surgery is estimated to work in 80%-90% of cases.

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