I have no doubt that a number of people reading this will have suffered with tennis elbow, or lateral epicondylitis to give it its fancy name, at some point in their life. For patients, it can be a really tricky condition – it may get better by itself but can also last for weeks or months without improvement, so what causes it?
First, we need to know a little bit about the elbow. The elbow joint is made up of three bones – the humerus (upper arm) and the radius and ulna (forearm). Around these bones are muscles that control movement of the elbow, wrist, and fingers. The muscles are joined to the bones by tendons, and these control the forearm muscles. Tennis elbow occurs when these muscles are overused – often by doing repetitive movements that cause strain on the muscles and tendons. The strain causes tiny tears and inflammation to occur in the tendon around the bony part on the outside of the elbow (the lateral epicondyle). When you have this condition, it is this inflammation that causes the pain in the elbow. If it occurs on the inner side of the elbow, it’s called golfer’s elbow or medical epicondylitis.
Pain at the elbow is not the only symptom of tennis elbow. Often movements of the arm or hand that add stress to the damaged tendon can also cause pain; these might include lifting your arm, gripping a small object like a pencil, or the motion of twisting a door handle or jar lid. Some people even have difficulty straightening their arm without pain.
As I mentioned, in a lot of cases this condition will get better by itself. If you think you have symptoms of tennis elbow starting, it is really important to rest the injured arm. If you can, stop doing the activity that is causing the problem to prevent it getting worse. Applying an ice pack to the painful elbow several times a day and taking paracetamol may help. The inflammation may also be helped by either applying a non-steroidal anti-inflammatory gel to the area (such as ibuprofen or diclofenac gel) or by taking a tablet form. If you are taking a tablet anti-inflammatory, please make sure it is suitable for you to take – if you take certain medications, or have stomach or kidney problems, then it may be best avoided, so check with your pharmacist or GP.
There are lots of good exercises online that can help you do self-physiotherapy for tennis elbow. There is a useful resource on the website versusarthritis.org which demonstrates some simple exercises. In persistent or severe cases, having hands on physio input to massage and manipulate the affected area may help relieve the pain and stiffness, and improve the range of movement in your arm. Using an elbow clasp may also help relieve some pain. Elbow clasps are devices that strap around the forearm below the elbow. They apply pressure to take the strain away from the affected tendon, which allows healing to take place. These can be bought in pharmacies or online.
If after all these measures, if the tennis elbow is not improving, sometimes a steroid injection may be offered to help reduce the inflammation. Surgery to remove the damaged part of the tendon is a last resort, and rarely required.
Most cases of tennis elbow last between six months and two years. However, in about nine out of 10 cases, a full recovery is made within a year. If you have suffered with this condition, and can identify the cause, looking to see what or how you can change your movements may help you avoid a further flare up.
