Lateral elbow tendinopathy (LET - tennis elbow)

Tennis elbow can occur as a result of repetitive strain, wear and trauma on the attachment of the wrist extensors at the lateral epicondyle, Symptoms can include pain in/around the lateral aspect of the elbow which may radiate into the forearm muscles. The insertion of the muscle into the lateral area is usually tender on palpation. Pain is generally aggravated by movements which extend the wrist, such as gripping, twisting (e.g using a screw driver), computer use or unsurprisingly playing tennis! The incidence of tennis elbow is 1-3% in the adult population and the incidence rises in manual workers. It accounts for 4-7 consultations in General Practice.

Mechanism of onset, location of symptoms, severity and longevity of symptoms, limitation to function.

1. Pain upon resisted wrist extension.
2. Pain on resisted middle finger extension (with the shoulder at 90degrees, elbow straight, forearm supinated and the wrist in neutral)

Tennis elbow assessment video

None indicated in primary care.

• Cervical spine/ radiculopathy
• Elbow joint/articular issue
• Upper limb neural tension.

• Pain relief in line with agreed formularies/guidance
• Patient education, activity modification:
• NHS AAA MSK website
  • Patient information leaflet - LINK
  • Use of tennis elbow strap – LINK
• ****Injection: Injection as first line/ immediate management is not supported by the evidence. If persistent Sx (> 2/3 months), a one off injection can be considered in patients with troublesome/severe symptoms ensuring advised of risk of and evidenced based outcomes.

• Diagnostically uncertain
• Symptoms persist beyond 2- 3/12 and interfere with ADLs despite conservative management
• If suspect a non red flag cervical source suspected, particularly if bilateral symptoms – refer to physiotherapy through usual pathway.