A common musculoskeletal condition, known as lateral epicondylitis, causing pain on the outside of the elbow, near the joint. Although it is usually self-limiting, meaning it gets better without treatment, symptoms may last 6-24 months. Pain on the inside of the elbow, medial epicondylitis is less common and known as golfer’s elbow.
The elbow joint is surrounded by muscles that move the elbow, wrist and fingers. The tendons in the elbow join the bones and muscles together, and control the muscles of your forearm.
Pain ranges from mild discomfort while using the elbow to severe pain even when the elbow is still. It can be felt on the outside of upper forearm, below the elbow bend and can travel down to the wrist, forearm and back of hand. Pain can be experienced when lifting, bending or extending the arm, twisting the forearm to open a jar or door handle or gripping small objects, like a pen or screwdriver.
Strenuous overuse of the muscles and tendons, particularly those of the forearm which are used to straighten the wrist. Strain can cause tiny tears and inflammation where these attach near the bony lump at the outside of the elbow, called the lateral epicondyle. This can result from repetitive activities that twist the wrist such as racquet sports, throwing javelin or discus, decorating with a paintbrush or roller, using a screwdriver, garden shears or scissors, typing or playing the violin, etc.
If rest does not ease the pain, the doctor will check for swelling and tenderness and ask you to extend your fingers and flex your wrist with elbow extended; ultrasound or MRI scans are only used if nerve damage is a suspected cause of pain.
No single intervention proven the most efficient, some combination treatments give better results; more studies are needed.
Physical Therapy/Osteopathy massage and manipulation to relieve pain, encourage blood flow, improve movement. Resistance exercises to stretch and strengthen muscles, reduce pain, improve grip strength. Strapping, taping, support bandage or splint to reduce pain, improve grip strength. Cyriax deep friction techniques and supervised exercise program both beneficial; conflicting studies regarding treatment of choice between these two and steroid injections.
Acupuncture with needles and laser beneficial short term.
Platelet rich injections using an extract of the person’s own blood; not proven effective.
Bone marrow injections using plasma rich in growth factors and mesenchymal stem cells; significant short to medium term improvement, further development needed.
Corticosteroid injections into the joint may help reduce pain; long term effectiveness not proven.
Medicinal leech therapy used where pain is major symptom. Leeches inject saliva with anti-inflammatory, thrombolytic, anti-coagulant and blood and lymph circulation enhancing properties into the tissues during blood withdrawal; specific analgesic substance in leech saliva
not yet identified. Leech therapy pain relief is often rapid, effective and long-lasting.
Drugs painkillers like paracetamol and anti-inflammatory (NSAIDs) like ibuprofen, also available as topical cream or gel.
Shock wave therapy through the skin may reduce pain, can cause minor bruising and skin reddening; more research needed.
Non-surgical treatments not better in longer term.
Surgery Arthroscopy may be recommended as a last resort, to remove the damaged part of the tendon.
Avoid straining elbow tendons and using the wrist and elbow more than the rest of the arm, include larger upper arm and shoulder muscles. Improve technique and strength for sports and activities than can cause tennis elbow; warm up and stretch beforehand. Use tools/rackets of appropriate weight for your strength and keep grip size bigger to avoid strain.
We are happy to advise you on your health matters and offer a free 15 minute elbow check, without obligation.