Tennis Elbow

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

Tennis elbow, medically referred to as lateral epicondylitis, is a condition characterised by pain and inflammation on the outer part of the elbow. It occurs when the tendons connecting the forearm muscles to the elbow become overworked, often due to repetitive motion or strain.

Though commonly associated with tennis players, it can impact anyone performing repetitive arm and wrist movements. If left untreated, it can cause chronic pain and a significant decrease in arm strength and functionality.

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Tennis Elbow

Symptoms of tennis elbow vary in intensity and can significantly interfere with everyday tasks.

Pain and Tenderness: Pain is commonly experienced on the outer part of the elbow and may extend down the forearm. It often starts as mild discomfort and progressively worsens over weeks or months. The pain can be sharp during activities like gripping or lifting, or it may feel dull and persistent at rest.
Reduced Grip Strength: Individuals with tennis elbow often experience reduced grip strength, making it difficult to hold objects like a cup or racquet. In severe cases, even light objects may become challenging to grasp or lift.
Difficulty with Movement: Bending or straightening the arm may cause stiffness or discomfort, particularly after periods of inactivity. In advanced cases, fully straightening the arm can become increasingly difficult.

Causes and Risk Factors

Tennis elbow arises from repeated stress on the forearm muscles and tendons, leading to small tears and inflammation. The common causes and contributing factors include:

Repetitive Movements: Activities that require repeated wrist or forearm movements, such as playing tennis, using plumbing tools, screwdrivers, prolonged mouse use, or painting, can contribute to the development of this condition.
Improper Technique in Sports: Using poor form or technique during racquet sports can put excessive strain on the elbow, making injuries more likely. Using improperly fitted equipment, such as a racquet with the wrong grip size, can further stress the tendons and contribute to the development of tennis elbow.
Age and Occupational Risks: Tennis elbow is more common among individuals aged 30 to 50, as well as those who work in jobs that require repetitive arm movements, such as plumbers, carpenters, and chefs.

Diagnosis of Tennis Elbow

Physical Examination

Tenderness and pain around the elbow are evaluated through palpation and specific arm movements. Movements like gripping or wrist extension are tested to identify discomfort and measure arm strength.

Imaging Tests

X-rays or MRIs may be employed to exclude other issues such as fractures, arthritis, or soft tissue injuries. These imaging tools are particularly helpful in persistent or unclear cases.

Differentiating Other Conditions

Conditions like golfer’s elbow, which affects the inner side of the elbow, or nerve compression syndromes can present with similar symptoms. Other conditions, such as bursitis or arthritis, may also mimic the symptoms of tennis elbow and require specific tests for accurate differentiation.

Treatment Options

Treatment for tennis elbow focuses on alleviating symptoms and restoring function. It can range from conservative measures to surgery in severe cases.

Non-Surgical Treatment

Activity Modification

Adjusting or avoiding tasks that aggravate symptoms allows the affected tendon time to rest and heal. This helps prevent worsening of the condition and reduces the likelihood of further injury.

Physical Therapy

A physiotherapist may guide patients through specific exercises designed to stretch and strengthen the forearm muscles and tendons. These exercises aim to enhance mobility and reduce stress on the elbow.

Using Braces and Splints

Braces or splints provide support for the elbow while also relieving pressure on the affected tendon. This is especially useful for repetitive tasks or activities requiring wrist and forearm movement.

Medications

Over-the-counter anti-inflammatory drugs, such as ibuprofen or naproxen, can help reduce pain and inflammation. These are typically used alongside other treatments to manage symptoms effectively.

Injection Therapies

Corticosteroid injections provide short-term relief by reducing inflammation but are not recommended for long-term management, as repeated use can weaken the tendon and exacerbate symptoms. Platelet-rich plasma (PRP) therapy promotes tissue healing and may be used for chronic cases.

Surgical Treatment

Open Surgery

In open surgery, a single incision is made over the affected area to access the damaged tendon. The surgeon removes the damaged tissue and may either release or reattach the healthy tendon to reduce strain. This procedure provides direct access to the affected area and is effective for addressing severe or chronic cases, though it requires a longer recovery period.

Arthroscopic Surgery

Arthroscopic surgery is a minimally invasive approach involving small incisions and the use of a camera (arthroscope) to guide the surgical instruments. The surgeon removes damaged tissue and treats the tendon through these small incisions. This method often results in less pain and a faster recovery compared to open surgery.

Prevention and Management

Preventing tennis elbow involves using ergonomic tools and maintaining muscle health to reduce tendon strain. Proper technique during activities and using well-fitted equipment, such as racquets or tools, can lower stress on the elbow. Workplace adjustments, like wrist rests or adjustable chairs, can help minimise strain. Regular stretching and strengthening exercises for the forearm muscles and taking breaks during repetitive tasks can prevent overuse. Gradually increasing the intensity of activities can help prevent sudden strain on the tendons.

Frequently Asked Questions

How long does it take for tennis elbow to heal without treatment?

Mild cases of tennis elbow may heal within a few weeks to months with rest. Recovery may take longer without activity modification or physical therapy, and symptoms may persist or worsen.

Can sleeping positions impact tennis elbow recovery?

Yes, sleeping with the arm bent or under the body can put additional strain on the tendons and exacerbate symptoms. Keeping the arm in a neutral position may help alleviate discomfort.

Is it safe to continue exercising with tennis elbow?

Low-impact activities like walking or swimming that do not strain the forearm can usually be continued. Exercises or tasks that cause pain should be avoided to prevent further injury.

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

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Mt Elizabeth Novena Specialist Centre

38 Irrawaddy Road #08-62/63
Singapore 329563

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