Tennis Elbow (Lateral Epicondylitis): Symptoms and Treatment in the UK

Tennis elbow, medically known as lateral epicondylitis, is a common musculoskeletal condition characterised by pain on the outer side of the elbow. Despite its name, only about 5% of people with the condition actually develop it from playing tennis. In the UK, it is most frequently seen in adults aged between 30 and 50, often linked to occupational tasks or hobbies that involve repetitive wrist and forearm movements.

The condition occurs when the tendons that connect the forearm muscles to the lateral epicondyle (the bony bump on the outside of your elbow) become overloaded. This results in small micro-tears and inflammation. According to NHS guidance, it is primarily an overuse injury caused by the repetitive contraction of the extensor muscles used to straighten and raise your hand and wrist.

Recognising the Signs

The primary symptom of tennis elbow is pain and tenderness on the outer part of the elbow. This pain may also radiate down the forearm towards the wrist. Patients often report increased discomfort when:

• Lifting or bending the arm.
• Gripping small objects, such as a pen or a coffee cup.
• Twisting the forearm, such as turning a door handle or opening a jar.
• Extending the wrist against resistance.

Who is at Risk in the UK?

While sport is a factor, many UK patients develop tennis elbow through manual labour. Decorators, bricklayers, carpenters, and even those who spend long hours using a computer mouse are at risk. NICE (the National Institute for Health and Care Excellence) highlights that repetitive forearm rotation and heavy lifting are the most significant risk factors for developing lateral epicondylitis.

The management of tennis elbow in the UK follows a tiered approach, starting with non-invasive measures. Most cases (around 90%) will improve without the need for surgery, although the recovery process can be slow.

Self-Care and Rest

The first step in treatment is identifying and stopping the activity that caused the pain. Using a cold compress or ice pack for 15 minutes several times a day can help reduce swelling and dull the ache. Over-the-counter medication such as paracetamol or topical NSAIDs (like ibuprofen gel) are often recommended to manage discomfort.

Physiotherapy and Bracing

Physiotherapy is a cornerstone of recovery. A therapist can provide specific exercises to strengthen the forearm muscles and improve flexibility. Some patients find relief using an epicondylitis clasp or a 'tennis elbow brace', which helps distribute pressure away from the injured area. NICE guidelines also suggest that eccentric loading exercises—slowly lowering a weight with the wrist—can be particularly effective for long-term healing.

If the pain is persistent and is affecting your ability to perform daily tasks or work, it is advisable to seek medical advice. You can speak to a GP online to discuss your symptoms and receive a clinical assessment. While an online doctor cannot perform a physical examination, they can often diagnose tennis elbow based on your history and the activities that trigger your pain.

An online GP service can provide guidance on effective self-care, recommend specific pain relief, and, where appropriate, issue sick notes if your workplace duties are preventing the tendon from healing. They can also explain the referral pathway to an NHS or private physiotherapist. If conservative treatments fail after several months, the GP may suggest a referral to a specialist for further imaging like an ultrasound or MRI scan.

For patients whose symptoms do not improve with rest and physiotherapy, further clinical interventions may be considered. These are usually discussed following a period of 6 to 12 weeks of conservative management.

• Steroid Injections: While once common, NICE guidance currently suggests caution. While they provide short-term relief, they may be less effective than physiotherapy in the long term and can occasionally weaken the tendon.
• Extracorporeal Shockwave Therapy (ESWT): This non-invasive procedure uses high-energy sound waves to stimulate healing in the tendon. It is often considered if other treatments have failed.
• Surgery: In rare, chronic cases where pain is debilitating even after a year of treatment, surgical intervention to remove the damaged part of the tendon may be required.

Preventing a recurrence of tennis elbow involves modifying how you move. If your work involves repetitive motions, ensure you take regular breaks. At the gym or while playing sports, check your technique with a professional to ensure you aren't putting undue stress on your extensors. Strengthening the muscles of the forearm and shoulder can also help the arm better tolerate the loads placed upon it.