This article was co-authored by Dr Ross Walker and Dr Stephanie Mathieson.

Tennis elbow is the common name for lateral elbow pain or lateral epicondylitis. It got its name of "tennis elbow", as it is often caused by the force of the tennis racquet hitting balls in playing a backhand shot. But the excess strain on the muscles and tendons on the back of your arm can occur for other reasons, such as frequent use of hand tools which cause repetitive movement. Some professionals like musicians, dentists, painters and carpenters are prone to tennis elbow because of the repeated motions required in the job. Tennis elbow affects approximately 3% of people who are 40 to 55 years of age (1).

Physiologically, the exact cause for tennis elbow is unclear as people who do not have symptoms like localised pain on the elbow's bony part can show changes in the tendon attachment in imaging studies.

Symptoms usually resolve quickly in the absence of treatment. 90% of people who do not seek treatment for their tennis elbow will completely recover or have much improved symptoms by one year (1).

The first-line treatment for tennis elbow is apparent, stop doing the repetitive activity causing the pain and tendinopathy. Although no specific treatment has been proven effective for tennis elbow, standard treatment often includes advice, education about the condition, and simple analgesia. Your doctor may prescribe some non-steroidal anti-inflammatory drugs to help manage the pain and help reduce any swelling and inflammation. However, these drugs are not long-term solutions and are not suitable for everyone to take. Other simple measures like using ice packs to reduce inflammation are often overlooked but can be a safe and effective pain management option.

There is also some evidence for the use of acupuncture and other related techniques for the relief of this condition.

In cases where changing work and daily activities and using simple analgesic pain medicines have not provided sufficient relief, steroid injections into the elbow may be considered as the next step. Surgery is rarely needed and should not be offered.

However, another treatment may help. Recent research has shown a medicine traditionally used for chest pain, when used at low doses, can help the healing process of tendinopathies as it increases blood flow to the area and is hypothesised to promote collagen synthesis in the injured tissue. The use of topical glyceryl trinitrate has been shown to reduce pain and improve movement and daily activities compared to placebo (2). But side effects may be experienced, such as headaches in one in five people. Tendinopathy assessed included the shoulder (rotator cuff), elbow, Achilles and knee tendons.

A recent small study of 14 people with plantar fasciitis (related to the insertion site of the Achilles tendon), demonstrated a significant symptomatic benefit with the use of injecting a person’s own abdominal fat, a rich source of stem cells and growth factors into the site of inflammation. Hopefully, this will also be trialled for tennis elbow. (3)

So, next time you play sport or do prolonged repetitive movements, do some warm-up exercises, no matter what sport you play!

References

1. Ikonen J, et al. Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clinical Orthopaedics and Related Research. 2021 Dec 7. doi: 10.1097/CORR.0000000000002058. Epub ahead of print.

2. Challoumas D, et al. Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review. British Journal of Sports Medicine. 2019;53(4):251-262.

3. Beth et al. Perforating Fat injections for Chronic Plantar Fasciitis. Plastic & Reconstructive Surgery, 2022; 149(2):297

Dr Stephanie Mathieson is a Research Fellow at the Institute for Musculoskeletal Health, University of Sydney.