Elbow tendinopathy (tennis and golfer's elbow)

What is elbow tendinopathy?

Elbow tendinopathy is a condition that causes elbow pain and forearm weakness.

Doctors use the term elbow tendinopathy when people have a problem with a tendon in the elbow. Depending on which elbow tendon is injured, the condition is also known as tennis elbow or golfer’s elbow.

In most people with elbow tendinopathy, the tendons are not inflamed or swollen. If they do get inflamed or swollen, doctors call it tendinitis.

Tendinitis usually starts suddenly. Tendinopathy usually happens over a longer period of time.

What are tendons?

Tendons are strong fibrous bands that attach muscles to bone. The tendons that move the wrist and forearm are attached to the elbow on both the inside (medial) elbow and outside (lateral) elbow. These tendons can become inflamed (tendinitis) or damaged from excessive force or overuse which causes pain.

Symptoms

The most common symptoms:

• Elbow pain – the pain can start slowly or suddenly. It can spread to the upper arm or forearm.
• Weakness of the forearm muscles
• Swelling (if people have tendinitis)

Causes

This condition can happen as people get older, especially if they do a lot of work or activity using their elbow and forearm.

Tendinitis can happen when people get hurt or do the same movements over and over.

Treatment

Most of the time, this condition will get better on its own, but it can take months to heal completely.

To help get better, you can:

• Rest your elbow and arm – ask your doctor about wearing an arm brace.
• Take a pain killer – your doctor might recommend that you take a medicine such as paracetamol and ibuprofen.

Initial treatment (First six weeks)

• Avoid activities that increase the pain. If you feel pain, you are probably irritating the tendon which may cause ongoing problems.
• Take simple pain killers like paracetamol and use an anti-inflammatory oral medication or cream (check with your doctor which pain medications are safe for you to take).
• Daily gentle stretching within pain-free limits (see stretching exercises diagram below), then later strengthening exercises may speed your recovery.
• A properly fitted arm brace will apply gentle pressure on your forearm muscles to relieve some of the pressure on the tendons.
• See a physiotherapist to have a thorough examination and to develop an individualised rehabilitation program.

Ongoing treatment (after six weeks)

• If your pain is not gone after six weeks despite the above treatment, your doctor may consider further investigations (X-ray or ultrasound).
• Having a steroid injection has been shown to improve pain initially but will not prevent the problem returning and may even do harm.
• Most people will get better with the above and only very severe cases that have failed rehabilitation may benefit from follow up with a specialist.

Strengthening exercises prescribed by your physiotherapist

A type of strengthening exercise known as isometric strengthening can assist in building up the strength in your forearm muscles and speed the recovery process.

These can be started once you’re able to move your wrist with little or no pain. A physiotherapist can provide these exercises to you when you are ready.

Home care

You can do different exercises to help with your symptoms. The right exercises for you will depend on which elbow tendon is injured.

The following exercises can help stretch the lower arm muscles:

• Tennis elbow stretch – Hold your injured arm straight out and point your fingers down to the ground. Use your other hand (with the thumb pressing on the palm) to grab this hand. Then press down on the back of the hand to bend the wrist more. Hold this position for 30 seconds. Repeat the stretch three times. Do this exercise one time a day.
• Golfer’s elbow stretch – Stand an arm's length away from the wall, with the injured arm closest to the wall. Put your palm on the wall, with your fingers pointing down. Press gently against the wall to stretch your muscles. Hold this position for 30 seconds. Repeat the stretch three times. Do this exercise one time a day.

Other types of exercises can help make the forearm muscles stronger. Your doctor, nurse, or physiotherapist can show you how to do these types of exercises. He or she will tell you when to start them and how often to do them.

Can elbow tendinopathy be prevented?

To help prevent elbow tendinopathy, you can:

• take breaks when you do activities in which you move your elbow and wrist a lot
• keep your elbows slightly bent when you exercise or lift things
• wear gloves or use two hands when using tools
• use a two-handed backhand swing in tennis
• use grip tape or padding on your golf clubs.

What to expect

Please contact your local doctor if you develop:

• changes in sensation of your arm or fingers, including pins and needles
• change in colour of your fingers or areas of your arm, for example blue or white
• pain that is worsening
• abnormal swelling around the affected area
• redness and heat in the area, or you develop fever-like symptoms.

Seeking help

In a medical emergency call an ambulance – dial triple zero (000). If you have any concerns, see your local doctor or healthcare professional. If this is not possible, return to the emergency department or urgent care centre.

For more information

Ask your local doctor or healthcare professional. You can also call healthdirect 24 hours a day on 1800 022 222 or visit healthdirect.gov.au.