Tennis elbow (lateral epicondylitis)
The term ‘tennis elbow’ is more correctly known as lateral epicondylitis and is a painful condition affecting the outside part of the elbow. The lateral epicondyle is the bony prominence at the outer part of base of the humerus or upper arm bone. A similar condition affects the medial epicondyle (the bony prominence at the inner part of the elbow) and is usually called 'golfer's elbow'.
What causes tennis elbow?
This is all because of our anatomy. The muscles that straighten out our wrist and fingers anchor onto a small bone at the outer side of the elbow. Repetitive movement under tension of these muscles can irritate the sheath these muscles are contained within and also cause tiny tears of the muscle too. The subsequent irritation and inflammation then causes all the symptoms and these symptoms are probably related to the poor healing process rather than to any original injury.
Who gets tennis and golfer's elbow?
Any sport, hobby or work activity in which repetitive arm movement, a type of RSI and muscle overstraining are involved can cause it, with the highest risk involving using a bent elbow while holding a racquet or tool. It also affects people more frequently over the age of 35 and both men and women are affected equally. It is uncommon in people under 30, probably because the healing ability of the tissues is better below that age.
How do I know I have tennis elbow?
It usually starts with discomfort on the outer part of the elbow that gradually increases with movement. Pressing on this part is painful as is bending the wrist upwards against pressure. The wrist may feel weak so picking up everyday objects such as books or pans may become difficult. Eventually, the pain travels all along the upper arm and outer part of the forearm and it may get so painful that the arm is held close to the body to prevent it hurting. There is usually tenderness over the lateral epicondyle in tennis elbow, and over the medial epicondyle in golfer's elbow.
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When will it get better?
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.
Healthwords pharmacists' top tips
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.
Using a clasp may help reduce the pressure on the elbow and allow you to play for longer pain-free periods.
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 high 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.
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When should I see my doctor? and what will the doc do
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.
Am I fit for work?
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.
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