Tennis elbow is damage to the tendons in the elbow that causes pain when using the forearm. Typically people will complain of pain when lifting heavy objects, twisting a lid off a jar or even when gripping a pen. If you stand with your arms straight and elbow creases facing forwards, you may feel pain if you press on the outermost part of your elbow. This bulge of bone is called the lateral epicondyle on the humerus, the upper arm bone. Tennis elbow is termed lateral epicondylitis, meaning that the tendons and muscles attached to this bone are inflamed. If you’re a tennis player, think of hitting an overhead serve – many muscles will come into play, but it’s this particular loading-twisting action that can aggravate this area. But it’s not exclusive to tennis pro’s - any repetitive sport or activity can cause this, it’s an overuse injury. You may notice pain appearing suddenly or it comes on gradually over weeks or months. Pain on the inside of the elbow joint, the medial epicondyle, is called golfer's elbow, and gives similar symptoms in but is painful over this part of the elbow.
Small microtears in the tendons build up and initiate a healing process, causing inflammation. The elbow needs time to repair itself, so will only heal if you ease off the activity that causes pain. Tendons are slow to heal and it may take several weeks to months for complete improvement. Once the cause has been identified, specialist input from a doctor or physiotherapist is rarely needed – it just needs time and rest.
Simple measures to help improve your symptoms include applying a cold compress or ice pack to the affected area during painful episodes. Some find compressive devices relieve tennis elbow discomfort, though the evidence for this is limited. Gentle stretching exercises and specific exercises (eccentric extension) can improve symptoms and speed up recovery. Simple painkiller medications can also provide relief. Anti-inflammatory gels or creams applied directly to the skin are the most effective. Examples include Voltarol gel (contains diclofenac), or Deep Heat (contains an aspirin derivative called methyl salicylate). Ibuprofen also comes in tablet form, take 200mg to 400mg up to three times a day for a few days, to relieve pain and swelling. Remember to take ibuprofen with food to avoid irritating the stomach. Speak to your doctor or pharmacist if you are taking other medicines, especially stroke prevention or blood pressure tablets, if you have kidney problems or you are pregnant. Paracetamol works in a different way, so can be added in as needed alongside ibuprofen. Take 1 to 2 tablets up to 4 times daily. Codeine-based medication can be used for a short time if you are in severe pain. Co-codamol (codeine combined with paracetamol) is available in the lowest dose from your pharmacy, or Nurofen Plus (codeine combined with ibuprofen) is available. Make sure you don’t double dose by also taking separate paracetamol, ibuprofen or aspirin.
For most people tennis elbow can be self-managed with the above strategies. Most important is a period of rest and avoidance of activities that cause pain. Where your symptoms are causing significant limitation or have not started to improve after the above simple measures you should make an appointment with your doctor. Your doctor may advise you on further options for painkillers, injections, exercises or they may refer you to a physiotherapist. If your symptoms are severe or longstanding your doctor may consider referring you to a specialist.
You are fit for work if you have tennis elbow. However, if your work requires tasks that cause your elbow pain to worsen, you may need to discuss the possibility of amended duties with your employer. They may send you to Occupational Health, if they have that available, or your doctor may be able to support this.