The basics
What is tennis elbow?
Tennis elbow (lateral elbow tendinopathy, or lateral epicondylalgia) is a problem with the tendon that attaches the forearm muscles to the bony point on the outside of the elbow. These muscles extend the wrist and fingers and work hard whenever you grip.
Despite the name, most people with tennis elbow don't play tennis. It is common in padel and other racket sports, and in work that involves repeated gripping, lifting or tool use, such as trades, desk work with a mouse, and rigging or kit handling. It is most common between the ages of about 35 and 55.
Signs to watch for
Symptoms of tennis elbow
- Pain on the outside of the elbow, sometimes spreading down the forearm
- Pain when gripping, lifting a kettle or a bag, shaking hands or turning a door handle
- Tenderness over the bony point on the outside of the elbow
- A weaker grip, or dropping things because of pain
Getting help
When to see a sports physician
Book an assessment if you have:
- Elbow pain that has lasted more than a few weeks
- Pain that is stopping you from working, playing sport or lifting everyday objects
- Pain that keeps coming back when you return to activity
- Elbow pain after a fall or injury
- Numbness, tingling or pain spreading into the hand
Diagnosis
How your elbow is assessed
Assessment starts with a history of your symptoms, work, sport and training, and an examination of the elbow, forearm, wrist and neck. Pain on the outside of the elbow can also come from the elbow joint, a trapped nerve or the neck, and these need to be ruled out.
Most cases are diagnosed from the history and examination. Ultrasound in clinic can be used to look at the tendon, check for a tear and rule out other causes. X-ray or MRI is arranged only if it will change your treatment.
Your treatment plan
Treatment options
Treatment depends on your diagnosis, how long you have had symptoms, your work and sport, and your goals. For most people, tennis elbow settles with a structured rehabilitation programme, although recovery often takes several months.
- 1
Rehabilitation and load management
A structured, progressive tendon-loading programme, together with changes to the grip, lifting and sport or work tasks that aggravate the elbow. This is the first step for everyone and the foundation of care. You are referred to a physiotherapist to guide the programme.
- 2
Shockwave therapy and high-power laser
Your physiotherapist may add shockwave therapy, usually over 3 to 6 weeks, or high-power laser, alongside your rehab programme. These may help some people with tendon pain. The evidence for them is mixed, they don't help everyone, and they are used with exercise, not instead of it.
- 3
Cortisone injections
A cortisone injection can ease pain in the short term, but in tennis elbow research has linked it to a higher chance of the pain returning later. Whether it is appropriate is assessed case by case.
- 4
Ultrasound-guided PRP injection
If symptoms haven't improved after about three months of rehabilitation, a single ultrasound-guided injection of platelet-rich plasma (PRP) may be considered, with your rehab continuing afterwards. The evidence for PRP in tennis elbow is mixed, it doesn't work for everyone, and medical aid often does not cover it.
- 5
Surgical referral
Surgery is rarely needed. If symptoms continue despite a full course of non-surgical care, we refer you to an orthopaedic surgeon.
Your visit
What to expect at your first consultation
- Your first consultation is longer than a follow-up visit, to allow time for a full history, an examination of your elbow and arm, and a discussion of your options.
- Please bring any previous X-rays, scans or reports, and a list of any medication you take.
- You leave with a diagnosis, or a plan to confirm it, and a written treatment plan, including your physiotherapy referral.
Questions
Tennis elbow: frequently asked questions
Do I need to stop playing tennis or padel?
Not always. Many people can keep playing at a reduced level if pain stays mild and settles by the next day. Changes to your racket, grip and how much you play can help. Your plan will set out what is appropriate for your elbow.
How long does tennis elbow take to get better?
It varies. Many people improve over a few months with rehabilitation, but tennis elbow can take longer to settle, especially if it has been present for a long time. Your progress is reviewed along the way.
Do I need a scan?
Usually not. Tennis elbow is mostly diagnosed from your history and examination. Ultrasound in clinic may be used to look at the tendon or rule out other causes. If you have already had scans, bring the images and reports.
Will a cortisone injection fix it?
Cortisone can ease pain in the short term, but it does not treat the tendon problem itself, and in tennis elbow it has been linked to a higher chance of the pain coming back. Whether it suits you is assessed case by case.
Do I need a referral?
No. You can book directly via WhatsApp. If you have notes from another doctor or physiotherapist, please bring them. Check with your medical aid about cover for your consultation.
Disclaimer: This page provides general information about tennis elbow for patient education only. It is not medical advice and does not replace a consultation. For medical advice about your own condition, please consult Dr. Ganda or your own healthcare provider.