What helps tennis elbow, and how long does it last?

What is tennis elbow?

Tennis elbow, also called lateral elbow tendinopathy or lateral epicondylalgia, is pain on the outer side of the elbow where the tendons of the forearm muscles that extend the wrist and fingers attach to the bone. It results from overload of these tendons, often from repetitive gripping, lifting or wrist movements.

Despite the name, most people with tennis elbow do not play tennis. It is common in middle age and in jobs or hobbies involving repetitive hand use, such as manual trades, computer work and gardening.

What are the symptoms?

Pain on the outer elbow that may spread into the forearm, worsened by gripping, lifting with the palm facing down, shaking hands, turning a door handle or holding a cup. The area is often tender to touch, and grip strength may feel weaker because of pain.

Symptoms usually start gradually. The elbow joint itself moves normally in most cases, which helps distinguish tennis elbow from joint problems.

Which treatments are recommended?

A clinical practice guideline on lateral elbow pain supports education about the condition and load management, progressive exercise that loads the forearm muscles, manual therapy techniques, and a counterforce brace or wrist splint for short-term symptom relief 1.

Exercise usually starts with gentle isometric holds or slow controlled wrist extension movements with light weights, then progresses to heavier resistance and functional tasks such as gripping and lifting over several weeks.

Do steroid injections help tennis elbow?

A randomised, placebo-controlled trial of 165 adults with tennis elbow lasting more than six weeks compared steroid injection, placebo injection and physiotherapy combinations 2. At one year, complete recovery or much improvement was reported by 83 per cent after steroid injection compared with 96 per cent after placebo injection, and recurrence was 54 per cent compared with 12 per cent 2.

In the same trial, the physiotherapy and no physiotherapy groups did not differ in one-year recovery (91 per cent compared with 88 per cent) 2. These findings have led many clinicians to avoid steroid injections as a routine treatment for tennis elbow.

How long does tennis elbow last?

Tennis elbow is often persistent, lasting several months, but the long-term outlook is favourable, and most people report recovery or considerable improvement within a year. Recovery can be slower when the aggravating activity continues unchanged.

Adjusting technique, such as lifting with the palm facing up, using a larger grip on tools and taking regular breaks from repetitive tasks, helps reduce load while the tendon adapts.

What about shockwave, PRP and surgery?

Other treatments, such as shockwave therapy and platelet-rich plasma injections, have been studied with mixed results. They are sometimes considered for persistent symptoms, after discussing the uncertain evidence.

Surgery is rarely required and is generally reserved for severe symptoms that persist for many months despite a well-conducted rehabilitation programme.

How can work and sport technique be adjusted?

Small changes in technique can reduce load on the forearm tendons. At work, this may include using tools with larger handles, keeping the wrist in a neutral position when typing, using a mouse that reduces wrist extension and taking regular breaks from repetitive tasks.

In racquet sports, a coach can check grip size, string tension and backhand technique. Gradually increasing playing time after a break and including forearm strengthening in regular training help prevent recurrence.

When should elbow pain be checked by a doctor?

Seek assessment for elbow pain after a fall or injury, swelling of the joint, loss of elbow movement, fever with a hot swollen elbow, or numbness and tingling in the hand.

Pain on the inner side of the elbow is more likely to be golfer's elbow, and pain spreading from the neck may come from a pinched nerve.

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