Tennis elbow - Newcastle Hospitals NHS Foundation Trust

Tennis elbow, also known as lateral epicondylitis is a common condition that results in pain on the outside of the elbow and occasionally into the forearm. The tendons of the forearm muscles attach to your elbow joint at a bony point on the outside of you elbow called the lateral epicondyle. These muscles extend the wrist and are important in gripping activities.

Tennis elbow affects approximately between 1 to 3 % of adults a year and is most common in the dominant arm. Despite its name, only 5% of people actually get tennis elbow from playing tennis. Common repetitive activities can increase your risk of developing tennis elbow. Tennis elbow can also occur following an injury to elbow.

Symptoms

The symptoms of tennis elbow usually include:

Pain on the outside of your elbow radiating into the forearm.
Pain and weakness on using the arm e.g. gripping and lifting.
Stiffness around the elbow and wrist.

The pain will often be worse when using your arm e.g. gripping small objects such as a pen, opening jars or doors or even filling the kettle. Repetitive wrist movements may also aggravate the symptoms. Occasionally you may experience pain and stiffness in other areas such as the neck and shoulder on the affected side. This is due to your body trying to compensate for the weakness in your elbow.

What can I do to help myself?

Most episodes of tennis elbow will resolve within six weeks if the correct advice and pain relief methods are followed. However, more severe cases can niggle on a lot longer. In nine out of ten cases, the symptoms will resolve within one year.

Pain relief

Simple analgesia such as paracetamol and an anti-inflammatory such as Ibuprofen can be very effective for the treatment of tennis elbow. You can obtain advice regarding medication from your local pharmacist or GP but remember to read the packet; and do not take over the recommended dosage.

Topical anti-inflammatory products in the form of a cream or gel can also be used. These are applied directly to the specific area of pain and are often recommended in the treatment of tennis elbow, as they can help reduce the pain and inflammation without the side effects of the anti-inflammatory tablets. For further information you should discuss this option with your GP or pharmacist.

Ice packs

Ice can be very effective in reducing the pain that results from tennis elbow.

Do not use ice if you have circulatory problems, such as Raynaud’s disease, history of cold induced hypertension, peripheral vascular disease, allergy to cold, urticarial, joint pain or sickle cell anaemia.

If your skin is usually numb over the injured area, please speak to your physiotherapist or GP before using a cold pack/ice.

Ice must be used correctly otherwise ice burns can occur. Please see the instructions below:

Start by wetting a cloth under a cold tap and then wring the cloth out until it is just damp.
Place the damp cloth over affected area and then place either a plastic bag of crushed ice or a packet of frozen peas on top of the cloth (The ice should be in small pieces to mould better to the area and help prevent ice burns).
Leave the ice pack and cloth in place for approximately 10-15 minutes and repeat 3 to 4 times a day.

It is normal for your skin to go slightly red or pink. Remove the ice if extreme redness/pain, blistering or an increase in swelling occurs. If this does occur, please contact NHS 111 for further advice.

Activity

Resting the affected arm when possible and avoiding / modifying activities that cause discomfort is one of the most effective treatment methods for tennis elbow.

You can modify aggravating activities so that they put less stress on the muscles and tendons of the forearm by:

Avoiding lifting, gripping or twisting the affected arm when possible.
Wearing an elbow clasp during aggravating activities – see below for further information.
Make sure that your palms are facing upwards when lifting to reduce the strain on your wrist muscles.
Using lightweight tools with a larger grip.
Ensuring you take regular breaks from repetitive tasks.

Elbow clasp

Wearing an elbow clasp / support when performing aggravating activities can help decrease the stress on the muscles and tendons of your forearm, preventing further micro-trauma and helping to ease the pain. You can buy these from pharmacy shops or online.

Exercises

The exercises on the following page have been designed by a physiotherapist to prevent stiffness or weakness of the elbow and wrist. If performed correctly and regularly they will aid your recovery, and help prevent reoccurrences of tennis elbow.

To be effective and prevent reoccurrence these exercises should be perform for 3 months.

Do not continue the exercises if they significantly increase your pain or swelling. If this were to occur, please see your GP / Physiotherapist for further advice.

Exercise 1 – Elbow flexion/extension

Bend and straighten your elbow. Repeat 10 times

Exercise 2 – Elbow pronation/supination

Keep your elbow at your side and bend to 90 degrees (right angle). Turn the palm of your hand towards the ceiling and then towards the floor.

Hold each stretch for 3 seconds.

Repeat 10 times.

Exercise 3 – Strengthening exercise programme

Level 1

Start with your affected arm bent to 90 degrees (right angle) at the elbow with your palm facing towards you. Place your other hand over the top. Apply pressure to GENTLY resist the extension of the wrist on your affected side (push your hands together). Neither hand should be moving. The exercise should be comfortable to perform.

Hold for 8 seconds.

Repeat 5 times.

Level 2

Start with your affected arm bent to 90 degrees (right angle) at the elbow with your palm facing the floor. Place your other hand over the top. Apply pressure to GENTLY resist the extension of the wrist on your affected side (push your hands together). Neither hand should be moving. The exercise should be comfortable to perform.

Hold for 8 – 15 seconds.

Repeat 5 times.

Level 3

Start with your affected arm straight out in front of you, with your elbow extended and your palm facing the floor. Place your other hand over the top. Apply pressure to GENTLY resist the extension of the wrist on your affected side (push your hands together). Neither hand should be moving. The exercise should be comfortable to perform.

Hold for 15 – 30 seconds.

Repeat 5 times.

Exercise 4 – Strengthening exercise

Holding one end of a water bottle or hammer with a light grip. Keep your elbow bent to 90 degrees and slowly turn your forearm towards the floor and then towards the ceiling.

Repeat 10 – 20 times

What about work?

Maintaining all normal activities including work improves your chance of recovery by keeping you moving. This helps you keep your ‘work fitness’ and prevents your elbow getting weak, which can prolong your pain.

Remember… You do not have to be pain free to return to or remain at work.

It may be necessary to do temporary lighter or modified duties. This should be discussed with your line manager initially. If further clarification is needed your Occupational Health advisor can identify more specific role modifications

What should I do if I am still experiencing problems?

If you are unable to agree on restricted roles with you manager or you are still having problems (despite following this advice): your Occupational Health team can help. The Occupational Health team can advise you on how to bridge the gap to help you return to normal activities. You can also gain access to the Occupational Health physiotherapy team by:

Self-referral

The Occupational Health can assist in the management of musculoskeletal problems that affect your ability to work. Staff are able to self-refer to physiotherapy via Occupational Health.

Management referral

If you feel your symptoms are having a significant effect on your ability to carry out your role, discuss this with your manager and request a referral to the Occupational Health Service.