Epicondylitis - Treating tennis elbow

Tennis elbow is a self-limiting condition, which means it will eventually get better without treatment.

However, it can often last for several weeks or months, because tendons heal slowly. In some cases, tennis elbow can persist for more than a year.

A number of simple treatments can help alleviate the pain of tennis elbow. The most important thing you can do is rest your injured arm and stop doing the activity that caused the problem (see below).

Holding a cold compress, such as a bag of frozen peas wrapped in a towel, against your elbow for a few minutes several times a day can help ease the pain.

Invasive treatments, such as surgery, will usually only be considered in severe and persistent cases of tennis elbow, where non-surgical approaches have not been effective.

Read on to learn about the different treatments you may be offered. You can also see a summary of the pros and cons of these treatments, which allows you to easily compare your options.

Avoiding or modifying activities

If you have tennis elbow, you should stop doing activities that strain affected muscles and tendons.

If you use your arms at work to carry out manual tasks, such as lifting, you may need to avoid these activities until the pain in your arm improves.

Alternatively, you may be able to modify the way you perform these types of movements so they do not place strain on your arm.

Talk to your employer about avoiding or modifying activities that could aggravate your arm and make the pain worse.

Painkillers and NSAIDs

Taking painkillers, such as paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help ease mild pain and inflammation caused by tennis elbow.

As well as tablets, NSAIDs are also available as creams and gels (topical NSAIDs). They are applied directly to a specific area of your body, such as your elbow and forearm.

Topical NSAIDs are often recommended for musculoskeletal conditions, such as tennis elbow, rather than anti-inflammatory tablets. This is because they can reduce inflammation and pain without causing side effects, such as nausea and diarrhoea.

Some NSAIDs are available over the counter without a prescription, while others are only available on prescription. Your GP or pharmacist will be able to recommend a suitable NSAID.

Physiotherapy

Your GP may refer you to a physiotherapist if your tennis elbow is causing more severe or persistent pain. Physiotherapists are healthcare professionals who use a variety of methods to restore movement to injured areas of the body.

Your physiotherapist may use manual therapy techniques, such as massage and manipulation, to relieve pain and stiffness, and encourage blood flow to your arm. They can also show you exercises you can do to keep your arm mobile and strengthen your forearm muscles.

The use of an orthoses – such as a brace, strapping, support bandage or splint – may also be recommended in the short term.

Corticosteroid injections

Corticosteroid injections are sometimes used to treat particularly painful musculoskeletal problems. However, there is limited clinical evidence to support their use as an effective treatment for tennis elbow.

Corticosteroids are a type of medication that contain man-made versions of the hormone cortisol.

Corticosteroid injections may help reduce the pain of tennis elbow in the short term, but their long-term effectiveness has been shown to be poor.

The injection will be made directly into the painful area around your elbow. Before you have the injection, you may be given a local anaesthetic to numb the area to reduce the pain.

Shock wave therapy

Shock wave therapy is a non-invasive treatment, where high-energy shock waves are passed through the skin to help relieve pain and promote movement in the affected area.

How many sessions you will need depends on the severity of your pain. You may have a local anaesthetic to reduce any pain or discomfort during the procedure.

The National Institute for Health and Care Excellence (NICE) states that shock wave therapy is safe, although it can cause minor side effects, including bruising and reddening of skin in the area being treated.

Research shows that shock wave therapy can help improve the pain of tennis elbow in some cases. However, it may not work in all cases, and further research is needed.

Surgery

Surgery may be recommended as a last resort treatment in cases where tennis elbow is causing severe and persistent pain. The damaged part of the tendon will be removed to relieve the painful symptoms.