What Is the Best Treatment for Tennis Elbow?

Rest, ice, compression and elevation are the best treatment for tennis elbow, followed up with specific exercise and physical therapy.

Tennis elbow (lateral epicondylitis) refers to an injury to the outer elbow tendon that occurs after strenuous overuse of the muscles and tendons of the forearm, near the elbow joint. 

Tendinopathy (tendinitis or tendinosis) is the most common condition affecting the elbow.

When pain occurs on the inner side of the elbow it is often called golfer's elbow.

Tennis elbow usually affects the dominant arm (for example, the right arm in people who are right-handed). Symptoms of tennis elbow include:

• Pain that may have a sudden onset or that develops gradually over time
• Pain in the elbow that spreads into the upper arm or down to the forearm
• Pain when lifting or bending the arm
• Forearm weakness 
• Difficulty with activities requiring arm strength, such as sports that that involve hitting backhand or throwing a ball
• Pain when gripping objects
• Pain on twisting the forearm, such as when opening a jar or turning a doorknob
• Pain and stiffness on full arm extension

Tennis elbow is caused by overuse of the muscles attached to the elbow that are used to straighten the wrist. When the muscles and tendons are strained, inflammation develops near the bony lump (the lateral epicondyle) on the outside of the elbow.

As the name suggests, tennis elbow can be caused by playing tennis. However, elbow tendinopathy can also be caused by other activities, including work-related activities involving intense use of the wrist and forearm muscles, playing the violin, repetitive computer mouse use, and painting. 

Risk factors for developing tennis elbow include: 

• Age: most common in adults aged 30 to 50 years
• Occupation: Jobs that involve repetitive movements of the wrist and arm put people at higher risk for tennis elbow, such as plumbers, painters, carpenters, butchers, and cooks
• Sports: Tennis and other racket sports increase the risk of tennis elbow, especially in people who have poor stroke technique

Tennis elbow is usually diagnosed based on a physical exam, where a doctor will check the area for tenderness and swelling. The doctor may also ask you to extend your fingers and flex your wrist with your elbow extended. 

Other tests may be used to rule out other causes of the pain, such as nerve damage, and may include:

• Ultrasound
• Magnetic resonance imaging (MRI)
• X-rays
• Electromyography (EMG)

Treatment for tennis elbow involves both short-term pain relief and long-term health improvement of the tendons. 

Short-term treatment for pain relief of tennis elbow includes: 

• Rest: stop participation in activities that cause or aggravate the injury
• Pain medicines, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve)
• Arm brace 
• Flexibility exercises 
• Corticosteroid injection: a single injection may be used only if pain is severe and short-term pain relief is necessary
• Extracorporeal shock wave therapy

Long-term treatment to relieve tennis elbow and improve the health of the tendons includes: 

• Strengthening exercises: eccentric strengthening
• Physical therapy

Newer treatments that are being developed to promote tendon healing include:

• Ultrasonic tenotomy (TENEX procedure), which uses needles to promote healing of the tendon
• Injection of blood products such as platelet rich plasma (PRP)
• Acupuncture
• Nitroglycerin patches

These therapies are not yet proven. 

Surgery is not usually recommended unless symptoms have not improved after six or more months of nonsurgical treatment. Surgery for tennis elbow usually involves removing diseased muscle and reattaching healthy muscle back to bone.

Surgery for tennis elbow may be: 

• Open surgery
  • Usually an outpatient procedure; patients go home the same day
  • The most common approach 
  • An incision is made over the elbow
• Arthroscopic surgery
  • Usually an outpatient procedure; patients go home the same day
  • Uses small incisions and instruments

After surgery:

• A splint is worn for about a week
• After that, exercises to stretch the elbow and restore flexibility can begin
• About 2 months after surgery, light, gradual strengthening exercises are started 
• About 4 to 6 months after surgery patients can resume sports

About 90% of people with tennis elbow will recover without complications. When complications of tennis elbow surgery occur, they may include:

• Recurrent injury with overuse
• Tendon rupture due to repeated steroid injections
• Failure to improve despite nonsurgical or surgical treatment
  • May be due to nerve entrapment in the forearm

To prevent overuse and strain in the elbow and forearm that causes tennis elbow:

• Apply an ice pack to the injured area
• Maintain strength and flexibility in the arm muscles 
• Avoid repetitive motion
• Rest from activities that require extensive hand/wrist motions
• Decrease the grip tension 
• Use wrist supports when weight training
• Use a two-handed backhand in tennis
• Use the proper technique in tennis