Elbow Pain

Tennis elbow

What is tennis elbow?

Tennis elbow is a condition that causes pain around the outside of the elbow.

What causes tennis elbow?

  • Trauma to the outside of elbow
  • Repetitive stress to the tendons on the outside of the elbow
  • Associated with racquet sports such as tennis or badminton
  • Manual work such as painting or plumbing 

What the signs and symptoms of tennis elbow?

  • Pain over the outside of your upper forearm, just below the bend of your elbow
  • Pain increases while lifting or bending your arm or gripping small objects, such as a using a key
  • Pain also associated with twisting your forearm, such as turning a door handle or opening a jar

How do I manage this problem?

  • Rest: Mostly lateral elbow pain improves with rest. 
  • Medications: Simple painkillers such as paracetamol or ibuprofen may help to reduce your pain and allow you to return to normal daily activities. Please discuss with your pharmacist if you have any other medical problems or if you not sure which medication to take.
  • Ice pack: This will reduce any swelling and bleeding and ease the pain. Wrap an ice pack or a bag of frozen peas in a damp towel and apply to the area for a maximum of 15 minutes. This can be repeated every 3 hours. Avoid applying ice directly to the skin.
  • Elbow support/clasp: Support around the forearm muscles may help to reduce the pain of some activities. Tennis elbow clasps should be worn 2-3 centimetres below the elbow joint.
  • Activity modification: Changing the way you do things may be helpful in reducing the stress on tissues and encourage healing
  • Exercises: Strengthening and stretching exercises for your forearm muscles may help your symptoms. Please refer to the attached sheet for further guidance.

What other treatments are available?

If your symptoms are not improving over 2 months with these measures you may need further assessment and treatment.

  • Medications: Your GP may prescribe stronger anti-inflammatories or painkillers
  • Physiotherapy: Further specific stretching and strengthening exercises may be helpful to improve your symptoms. Your physiotherapist may use different forms of manual therapy to improve your symptoms.
  • Eccentric loading exercises: These exercises are proven to be effective in managing tendon problems including tennis elbow. You should try these exercises for at least 12 weeks before trying steroid injections.
  • Steroid injections: These may be helpful if your symptoms do not improve with physiotherapy over 3-6 months.
  • Surgery: This is rarely recommended for tennis elbow. It involves realigning your tendons as well as surgically removing the scar tissue over the tendons.

Eccentric loading exercise programme

  1. Seated in a chair, support the forearm over the edge of a table or over your knee and hold the weight in the hand with the palm facing down.
  2. Maintain your wrist fully bent downwards. By using your unaffected hand lift your wrist up all the way back.
  3. Then slowly lower the weight until the wrist is fully bent (flexed).
  4. Repeat this movement to 15 repetitions. It is important you release the hand slowly dowards
  5. After 15 repetitions rest for couple of minutes then do a further 15 reps. 
  6. Do 3 x sets of 10-15 repetitions, twice daily.
  7. You may do some of the stretching and massage with anti-inflammatory gel or ice packs after you do the exercise.
  8. You may feel sore and tender during or immediately after the exercises but don't worry this should gradually improve.
  9. Remember you WILL NOT notice immediate results as it generally takes 8 to 12 weeks to improve.

Advice

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