Tennis elbow

Jun 24, 2019

Tennis elbow is the most common cause of elbow pain, affecting up to 3% of the general population. It is associated with a marked reduction in quality of life and absenteeism from work.

Tennis elbow is a form of tendinopathy, similar to achilles tendinopathy in the lower leg. Tendinopathy is a term that encompasses any problem with the tendon, this can mean inflammation (tendinitis) or degeneration (tendinosis). Tendon health is affected by smoking, obesity, high fatty food intake, diabetes and sudden increased activity levels.


  1. Localised pain experienced of the outside of the elbow, or common extensor muscles.
  2. No obvious onset, but often due to sudden increased activity levels.
  3. Pain experienced with wrist movements and gripping.


The strongest current scientific evidence for rehabilitation of tennis elbow is a combination of exercise and manipulation.

  1. Exercise is central to successful management. Gradual strengthening/loading of the extensor muscles for a minimum of 12 weeks.
  2. Manipulation of the elbow joints and soft tissues can reproduce immediate improvement in pain, this is due to a neuro physiological response. Hands on treatment to the neck, shoulder and upper back is also recomended to improve pain and function.
  3. Elbow clasps or braces may be as effective as a cortico steroid injection, for reducing pain and increasing function. No one type of clasp appears superior to others.

Cortico steroid injections are not recomended. Scientific evidence suggests that injections are associated with increased chronicity of local soft tissues, increased re occurance rates of tennis elbow (10x more likely to have a re occurance) and potential rupture of the extensor tendon from its attachment point. Cortico steroid injections could be seen to lead to short term gain but long term pain!


MRI or ultrasound is only recomended if there is a lack of significant improvement with conservative treatment, or if there was a traumatic onset that could have let to a rupture of the extensor tendon.

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