Tennis Elbow

What is a ‘Tennis Elbow’ (common extensor tendinopathy)?

A common extensor tendinopathy (tennis elbow) refers to pain and a weakening to the fibres of the tendon attaching the muscles of your forearm to the outer bone of your elbow (lateral epicondyle).

Although rackets sports players can develop a common extensor tendinopathy, the vast majority of individuals who develop symptoms do so as a result of prolonged, repetitive activities including warehouse or desk-based work, often with a poor ergonomic setup.

Common Symptoms

Localised pain is felt directly over the common extensor tendon in the outer elbow which sometimes radiates down the forearm muscle bulk.

Symptoms are aggravated by any activity which requires repeated use of the wrist extensor muscles. Common examples may include working at a computer (keyboard or mouse work) or gripping, lifting or carrying tasks.

How is a Tennis Elbow diagnosed?

A common extensor tendinopathy can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition. In some circumstances it may be necessary to conduct a physical examination but this is usually not necessary in uncomplicated tennis elbow.

The main features are tenderness directly over the tendon insertion on the lateral bony point of the elbow. There is also pain directly over the tendon when contracting the forearm muscles against resistance (eg when gripping or resisting wrist extension).

Scans are not routinely required.

How is a Tennis Elbow treated?

A common extensor tendinopathy can be managed effectively by adhering to the following advice and exercise routine.

Modifying aggravating activities. If there are some particularly stressful tasks such as DIY or racket sports which seem to be aggravating your symptoms, then the common extensor tendon may need 4-6 weeks of relative rest.

Ergonomic adjustments. If the condition has been triggered by repetitive computer work, changes to your overall sitting position to ensure a neutral elbow and wrist position as well as some specialist keyboard and mouse equipment can significantly reduce the stresses placed on the common extensor tendon:

Appropriate DSE set up

Exercises. Regular exercises to strengthen the wrist extensor muscles and tendon in the forearm and stretch the flexor muscles:

3×15 repetitions 3-4x per week

5×30 second holds, 2x per day

These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your GP or Physiotherapist.

Corticosteroid injection therapy. Evidence suggests that if possible, corticosteroid injections are best avoided as the steroid may weaken the tendon in the longer term. However, injections may be discussed with individuals who continue to suffer disabling pain (preventing work and leisure activities) and have failed physiotherapy management. You can read more about local corticosteroid injections here.