The pain caused by tennis elbow can last for some time. As tendons are slow to heal, the symptoms often last for a number of weeks or months. In severe cases, tennis elbow can persist for more than a year.
However, tennis elbow is a self-limiting condition, which means it will eventually get better with or without treatment.
There are non-surgical and surgical treatment options for tennis elbow. Before surgery is considered, managing the symptoms using non-surgical treatment is recommended. Surgery will only be recommended as a treatment of last resort, after non-surgical methods have not worked.
Non-surgical treatments
If you have tennis elbow, you should rest the affected arm as much as possible and avoid doing any activities that put more stress on the tendons (see box, left).
Painkillers
Taking painkillers, such as paracetamol and ibuprofen, may help to reduce mild pain that is caused by tennis elbow. Children under 16 years old should not take aspirin.
Non-steroidal anti-inflammatory drugs (NSAIDs)
As well as tablets, anti-inflammatory painkillers are also available as creams and gels. These are often known as topical NSAIDs because they are applied directly to a specific area of your body, such as your forearm or elbow.
Some NSAIDs are available at pharmacists over the counter. Others are only available on prescription. Your pharmacist or GP can advise you about which NSAID is most suitable for you.
Examples of topical NSAIDs include:
- ibuprofen
- ketoprofen
- piroxicam
These have been proven to provide some pain relief for musculoskeletal conditions (those that affect the muscles or bones), such as tennis elbow.
NSAID creams or gels should be gently rubbed into the area that is causing pain and discomfort. Make sure that you read the patient information leaflet that comes with your cream or gel to check how often the treatment should be applied.
Anti-inflammatory creams and gels are often recommended for tennis elbow rather than anti-inflammatory tablets. This is because gels and creams provide effective pain relief and reduce inflammation without causing side effects, such as nausea and diarrhoea.
However, photosensitivity reactions can sometimes occur while using ketoprofen. Therefore, avoid exposing the affected area to sunlight while using ketoprofen and for two weeks after the treatment has finished.
Avoid using topical NSAIDs during pregnancy and breastfeeding. Many topical NSAIDs are also unsuitable for children. Ask your GP or pharmacist for advice if you are not sure about whether a topical NSAID is suitable for you or your child.
Corticosteroid injections
A corticosteroid injection may be recommended if you have particularly painful tennis elbow that is making movement difficult. Corticosteroids are a medication that contain steroids (a type of hormone). A corticosteroid injection will reduce the pain in your arm.
The injection will be made directly into the painful area around your elbow. Before you have the injection, you may be given a local anaesthetic to numb the area so you do not feel any further pain while the injection is being given.
Most people who have a corticosteroid injection find that their pain initially improves significantly. However, a study of 198 people has shown that corticosteroid injection treatment is only effective in the short-term (around six weeks), and its long-term effectiveness is poor.
Research has shown that when compared to physiotherapy and a ‘wait and see’ approach to see if symptoms disappear naturally, corticosteroid injections were not as effective at 52 weeks. They were effective in the short term, at six weeks after the treatment. High recurrence rates have also been reported in people who have corticosteroid injections.
The recommended time in between corticosteroid injections is six weeks.
Potential side effects of corticosteroid injections include:
- pain in the affected area after having the injection
- skin depigmentation – the loss of colour (pigment) around the injection site
- wasting away of the surrounding subcutaneous tissue (the layer of tissue beneath the surface of the skin)
Before you decide to have corticosteroid injections to treat tennis elbow, discuss the effectiveness and potential side effects with your GP. This will enable you to make a well-informed decision about this type of treatment.
After having a steroid injection (or injections), take care to rest your arm. Avoid putting too much strain on it too quickly. As with any injury, you should gradually build up to your normal activity levels to help prevent the problem reoccurring.
Physiotherapy
If your tennis elbow symptoms are particularly severe or persistent, your GP may refer you to a physiotherapist (a healthcare professional who is trained to use physical methods, such as massage and manipulation, to promote healing).
A physiotherapist will be able to show you exercises to help stretch and strengthen your forearm muscles. They may also recommend that you wear a splint (an elasticated band that is positioned just below the elbow joint) to help support your elbow and encourage the tendons to heal.
Shock wave therapy
Shock wave therapy is where high-energy sound waves are passed through the skin of the affected area to help relieve the pain of tennis elbow and improve mobility (movement).
Depending on the severity of your pain, shock wave therapy may be given once or it may be repeated. You may have a local anaesthetic during the procedure to prevent you feeling any pain while the shock waves are being passed through your skin.
Following shock wave therapy, potential side effects include:
- bruising
- red skin
- inflammation (swelling) of the skin
- skin damage around the area being treated
Research has shown that shock wave therapy is safe. However, NICE states that there is a lack of evidence of its effectiveness in treating tennis elbow, and more research is required.
Your GP may recommend shock wave therapy if other non-surgical treatments have proved to be ineffective in relieving your symptoms of tennis elbow. Discuss the potential risks, benefits and side effects with your GP.
Acupuncture
Acupuncture is a type of complementary treatment where fine needles are inserted into the skin around the affected area. In some cases, this may reduce pain and improve movement. However, there is a lack of evidence that it relieves the symptoms of tennis elbow.
Surgery
Surgery may be recommended as a last resort treatment option in rare cases of severe or persistent tennis elbow. Surgery aims to relieve the painful symptoms by removing the damaged part of the tendon.
