Lateral epicondylitis or lateral elbow tendinopathy

Warning

What Is Tennis Elbow?

  • A soft tissue problem
  • Pain around the outside of the elbow which can move down the forearm
  • It is a repetitive strain injury caused by overuse of the forearm muscles i.e gripping, lifting
  • It may also be called Lateral Epicondylitis or Lateral Epicondylopathy

 

Tennis Elbow is a condition that can get better on its own over time without treatment as long as you stop or reduce activities that aggravate it.

Typically, it can take between 6 months and 2 years to improve. 90% of people with symptoms will make a full recovery within a year.

What are the symptoms of Tennis Elbow?

You may experience one or all of the following:

  • Outer elbow pain on gripping or lifting
  • Outer elbow pain on opening jars/twisting movements of the wrist
  • Localised tenderness on the outside of the elbow
  • Stiffness on bending or straightening the elbow joint, particularly first thing in the morning
  • Occasionally mild swelling and heat can be present

 

How common is Tennis Elbow?

  • Tennis Elbow is a common condition within the UK.
  • Annually, it is estimated that 1 in 200 people consult their GP about Tennis Elbow symptoms.
  • It affects both men and women equally.
  • Tennis elbow mainly affects adults and most commonly affects those within the 40-60 age group.

 

What causes Tennis Elbow?

Some of the muscles that help to move your wrist and forearm attach via a tendon to a common point at the outside of your elbow. Straining these muscles can lead to small tears and inflammation within the tendon resulting in Tennis Elbow pain.

Overuse of these muscles can happen with small repetitive movements, such as typing and using a computer mouse or with strenuous activities. It can also be triggered by a sudden increase in manual activity. For example, tasks that you would not do on a regular basis like gardening, spring cleaning or D.I.Y.

Knocking or banging your elbow can cause soft tissue inflammation and can also very occasionally trigger Tennis Elbow.

 

What can help with Tennis Elbow?

Making changes to your lifestyle as well as reducing aggravating activities is key to aiding your recovery. Only you can do this.

There are a number of things you can do to help including:

  • Avoid painful movements particularly those that involve straining the forearm muscles
  • Reduce repetitive twisting movements of the wrist, gripping and lifting.
  • Make sure you take regular short breaks from activities that aggravate your elbow pain such as typing, lifting or repetitive work.
  • Change activities to reduce pain. For example, lifting/carrying objects with the palms facing up can be more comfortable. Use of ergonomic computer equipment can also be helpful. Your employer may be able to supply this following a work station assessment.
  • Limit the stress on the tendon by relaxing your grip as much as possible when lifting or driving.

Pacing and Spacing

  • Pacing and spacing methods can help you manage your pain better.
  • Pacing is the term used for breaking down an activity or task. This can be done by taking regular breaks. Prioritising daily activities can also help. This can prevent “over stimulating” your pain system.
  • When completing challenging tasks or activities, it may be useful to set a “baseline”. This is the amount you can manage on a good or bad day without increasing your symptoms. Therefore, you can plan rests and set achievable goals.

Exercise

Sometimes, specific exercises are needed to treat Tennis Elbow. It is important to note it can take 6 – 8 weeks of doing specific exercises to notice a difference in your elbow pain. 

Who to refer, who not to refer, how to refer

Who to Refer

  • Those who have failed non -surgical management

Urgent Referral Criteria 

  • Nil

Who Not to Refer

  • Those who have not tried non -surgical management

Additional Info

  • Steroid Injections are now very rarely offered due to the deleterious effects on tendon and poor success rates.

Primary care management

Primary care Management

  • Activity Modification
  • Pacing of Activities
  • Physiotherapy
  • Appropriate Analgesia/ NSAIDS
  • AVOID INJECTION

Imaging Pre referral

 

BMI >35 engage in wellbeing support

Resources and links

Primary Care Pathway – developed by First Contact Practitioners (To be confirmed, will update when available)

Exercises released By BESS -  https://youtu.be/oDPNW8EnToQ?si=ZoG9hBigYOLf6uuY

BESS National guidelines – BESS guidelines -Tennis-Elbow-2023.pdf

Editorial Information

Last reviewed: 31/07/2025

Next review date: 31/07/2027

Author(s): Mr Roshan Raghavan.

Author email(s): Roshan.Raghavan@nhs.scot.