Home / Conditions / Tennis elbow
Pain on the bony point on the outside of the elbow, worse when you grip, lift or shake hands. Despite the name, most people who get it do not play tennis — it comes from repeated gripping and twisting at work or at home. The tendon there has been overloaded, and most people recover, usually within a year or two.
Pain around the elbow has a few common sources, and they sit close together. Where exactly it hurts, and whether there is tingling, usually tells them apart.
| Tennis elbow | Golfer's elbow | Radial tunnel syndrome | From the neck | |
|---|---|---|---|---|
| Where it hurts | On the bony point on the outside of the elbow | On the bony point on the inside of the elbow | In the forearm muscle, a few centimetres below the outside | Running down from the neck into the arm |
| What brings it on | Gripping and lifting with the palm down | Gripping, lifting with the palm up, throwing | Twisting the forearm, gripping, pulling | Turning or tilting the neck |
| Other signs | A weak, painful grip | Tingling in the little finger points to the nearby nerve instead | Little weakness; tender over the muscle | Tingling or numbness in the hand |
| What it needs | Easing the load, exercises, time | Treated the same way | See radial tunnel syndrome | The neck assessed |
A hot, swollen elbow is not tennis elbow. A soft swelling over the point of the elbow with redness or a fever may be an infected bursa, and needs seeing the same day: call the clinic and come in, or go to an emergency department if we are closed. Tingling or numbness in the hand points to a nerve rather than the tendon.
The forearm muscles that lift the wrist and straighten the fingers join into a single tendon, which attaches to the bony point on the outside of the elbow. Every grip pulls on it — which is why gripping, lifting and shaking hands hurt.
What a picture cannot show is what has gone wrong. Its medical name, lateral epicondylitis, suggests inflammation, but the tendon has mostly been overloaded faster than it could adapt — which is why the right exercises, not simply rest, are what help it recover.
It also explains why it lingers. Tendons adapt slowly, so recovery takes months rather than weeks — but it does come, and most people are free of pain within a year or two.
Most people recover within a year or two whatever is done, so treatment aims to ease the pain and help the tendon adapt — without doing anything that makes it worse in the long run.
Cutting down on gripping and lifting with the palm facing down, and changing tools or technique at work or in sport. A forearm strap worn just below the elbow can take some of the strain off the tendon.
A programme to strengthen the forearm, especially slow lowering exercises, is the mainstay of treatment. It helps the tendon adapt, and improvement builds over several weeks to a few months.
For pain that has lasted months, shockwave therapy is an option; the evidence for it here is reasonable, alongside exercise rather than instead of it.
A steroid injection eases the pain quickly, but studies show the elbow is more likely to still hurt a year later than with exercise alone, so it is used sparingly. Surgery is considered only after six to twelve months of proper treatment has not helped.
Tennis elbow here is seen by Dr Jeffrey Tan Gek Meng, a Senior Consultant Orthopaedic Surgeon. His subspecialty is foot and ankle, and he also practises across general orthopaedics, which his profile says includes tennis elbow. He is a Fellow of the Royal College of Surgeons of Edinburgh and consults in English, Mandarin, Malay, Hokkien and Hainanese.
No. Most people with it do not play tennis at all. Any repeated gripping and twisting can cause it — using tools, carrying bags, typing, or lifting a baby.
Usually several months, and most people recover within a year or two. The right exercises and easing the load help it settle sooner.
It eases the pain quickly, but studies show the elbow is more likely to still hurt a year later than with exercise alone. It is worth discussing carefully before deciding, and is not usually the first choice.
It can. A strap worn just below the elbow spreads the pull on the tendon and eases the pain for some people, especially during activity. It works best alongside exercises.
It is the same kind of problem on the inside of the elbow instead of the outside, in the tendon of the muscles that bend the wrist. It is treated in the same way.
No. Bring any X-ray or scan reports, and be ready to say what movements bring on the pain.
Radial tunnel syndrome · Cubital tunnel syndrome · Pinched nerve in the neck · Shockwave therapy
Be ready to say what movements bring on the pain, and whether you have had an injection before.
