Tennis Elbow Treatment in London

What is tennis elbow?

Tennis elbow (lateral epicondylitis, or lateral elbow tendinopathy) is a painful overload of the tendon that attaches the forearm muscles to the outer side of the elbow. It affects 1 to 3% of adults, with a peak between the ages of 35 and 55. Fewer than 1 in 10 cases relate to tennis.

Most people recover with activity change, physiotherapy and time. A small group with symptoms beyond 6 to 12 months may benefit from surgery.

Symptoms

Pain builds over weeks rather than after a single injury. Common symptoms are:

Pain and tenderness over the bony bump on the outer side of the elbow
Pain spreading down the back of the forearm
Pain when gripping, lifting a kettle, shaking hands or turning a door handle
A weaker grip
Stiffness and ache first thing in the morning

Numbness or tingling in the hand is not a feature of tennis elbow. It points to another diagnosis, such as a trapped nerve.

Causes and who is at risk

The tendon at fault is the extensor carpi radialis brevis (ECRB), which takes load each time you grip or lift the wrist. When load exceeds the tendon's capacity to adapt, its structure changes. Under the microscope this is degeneration, not inflammation, which is why "tendinopathy" has replaced "tendinitis".

Risk factors include:

Repetitive gripping or wrist movement at work, including manual trades and keyboard and mouse use
Racquet sports, golf, weight training and climbing
Playing a musical instrument, including strings, keyboard and percussion
A sudden rise in activity, such as DIY, gardening or a new training block
Smoking and a raised body weight
Age between 35 and 55

How is tennis elbow diagnosed?

Diagnosis is clinical. At your consultation I take a history of your work, sport and any instrument you play, and examine the elbow, neck and nerves of the arm. Key findings are:

Tenderness over the outer bony point of the elbow (lateral epicondyle)
Pain when you resist straightening the wrist or middle finger
Pain when you lift a chair with the palm facing down

Not every patient needs a scan. I arrange ultrasound or MRI when symptoms persist, when the diagnosis is uncertain, or before any procedure. Imaging shows the extent of tendon damage and excludes conditions that mimic tennis elbow:

Radial tunnel syndrome, a compression of a branch of the radial nerve
Arthritis of the elbow joint
Ligament instability of the elbow
Pain referred from the neck

Non-surgical treatment

In trials, 80 to 90% of people recover within 12 months without surgery. Treatment aims to settle pain and rebuild the tendon's capacity to take load.

Load modification. Reduce, rather than stop, the activities that provoke pain. Lift with the palm facing up where you can.
Hand therapy and physiotherapy. A graded loading programme, starting with static holds and building to slow, heavier resistance, has the strongest evidence. Expect 8 to 12 weeks.
Counterforce brace. A strap worn below the elbow can ease pain during activity.
Pain relief. Anti-inflammatory gels give short-term relief.
Technique and equipment review. Grip size, racquet, mouse and workstation set-up, and instrument posture.

Injections

Steroid injection eases pain for a few weeks. Trials show more recurrence and poorer outcomes at one year compared with no injection, so I reserve it for selected cases.
Shockwave therapy is an option for persistent symptoms, with modest supporting evidence.

Surgery and recovery

Surgery is an option when pain persists beyond 6 to 12 months despite a full course of non-surgical treatment, and imaging confirms tendon damage. Fewer than 1 in 10 patients reach this stage.

The operation

Day-case procedure under general or regional anaesthetic
Removal of the damaged tendon tissue through a small open incision or by keyhole (arthroscopic) surgery
Keyhole surgery allows a look inside the joint for other causes of pain
The operation takes 30 to 45 minutes

Case series report good results in 80 to 90% of patients. One small placebo-controlled trial found no difference between surgery and a sham operation. For this reason I recommend surgery once other options are exhausted, and we discuss the evidence in full before you decide.

Recovery timeline

Time after surgery

What to expect

0 to 2 weeks - Sling for comfort for a few days; gentle hand and elbow movement

2 weeks - Wound check and stitch removal; hand therapy begins

2 to 4 weeks - Return to desk work; driving once you can grip the wheel with control

6 to 8 weeks - Strengthening begins

3 to 4 months - Return to sport, heavy manual work and full instrument practice

Up to 12 months - Strength continues to improve

Complications are uncommon. They include infection, irritation of nearby nerves, elbow stiffness, weakness and persistent pain.

When to see a specialist

Book an assessment if:

Pain has lasted more than three months despite activity change
Pain wakes you at night or stops you working, training or playing
You have numbness, tingling or weakness in the hand
Pain began after a fall or injury, or the elbow feels unstable or locks
You are a musician or athlete with a performance or competition ahead

Frequently asked questions

Will tennis elbow go away on its own?

In most cases, yes. Trials show 80 to 90% of people recover within a year. Treatment shortens recovery and lowers the risk of the pain returning.

Should I rest my arm completely?

No. Complete rest weakens the tendon. Reduce the activities that provoke pain and follow a graded loading programme.

Is a steroid injection a good idea?

It eases pain for a few weeks, but trials link it with a higher chance of the pain returning within a year. I discuss alternatives with you first.

Can I keep playing tennis or my instrument?

In most cases, yes, at a reduced load. A review of your technique, equipment and practice schedule is part of treatment.

How long is recovery after surgery?

Most people return to desk work within 2 to 4 weeks, and to sport or heavy work by 3 to 4 months.

Do I need a GP referral?

Many insurers require one for a claim. Self-funding patients can book direct.