Golfers & Tennis Elbow

Tennis Elbow (lateral epicondylitis)

Despite its name, athletes are not the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters, and butchers.

Tennis elbow can occur at any age, although it most commonly occurs in people aged between 35 and 55. Up to 4 in 10 people may experience it at some point in their life.

Tennis elbow leads to pain and tenderness over the outer aspect of the elbow with the following characteristics:

• Pain: Tennis elbow leads to pain on the outside of your elbow. This pain can increase with gripping or rotation of the wrist and forearm e.g., opening a jar or a door. You may experience constant pain which could occur at rest and can affect your sleep. The pain can travel down your arm from your elbow towards your wrist.
• Weakness: Weakness in your wrist or reduction in your grip strength.
• Stiffness: Tennis elbow can cause stiffness and a general restriction of your movement.
• Tingling: Sometimes tingling and numbness can also be experienced.

Symptoms usually last for between 6 & 24 months with 80% of cases improving within 1 year whether they have received treatment or not.

Golfer’s Elbow (medial epicondylitis)

Golfer’s elbow is like tennis elbow but occurs on the inside of the elbow. It is not limited to golfers.

Golfer’s elbow affects men & women equally. It mainly affects people between the ages of 30 & 50 years old.

Golfer’s elbow is caused predominantly by activities that require repetitive or excessive bending of the wrist. Whilst an incorrect golf swing is a common cause, many other activities can also cause the problem (e.g., DIY, use of hand tools, typing or gardening). It can also result from a single violent trauma such as a direct injury from a fall or sudden blow to the elbow.

Golfer’s elbow is characterized by:

• Pain and tenderness. Usually felt on the inner side of your elbow, the pain sometimes extends along the inner side of your forearm. Pain typically worsens with certain movements.
• Stiffness. Your elbow may feel stiff and making a fist might hurt.
• Weakness. You may have weakness in your hands and wrists.
• Numbness or tingling. These sensations might radiate into one or more fingers — usually the ring and little fingers.

The pain of golfer’s elbow can come on suddenly or gradually. The pain might worsen with certain movements, such as swinging a golf club.

Most cases of golfer’s elbow will settle within a few weeks or months with the correct change of activity.

Tennis elbow & Golfer’s elbow are usually diagnosed based on the typical symptoms described above.

Tests are not usually needed to diagnose tennis or golfer’s elbow.

If there is any doubt about the diagnosis or your GP thinks the pain is due to nerve damage, further tests may be done.

You should consider consulting your GP with any of the following:

• Typical symptoms (see above) that are not settling after 6-8 weeks of rest & activity modification.
• A new lump or bump around the elbow
• Bruising or redness in and around the joint or new multiple joint swellings
• Feeling unwell with a temperature associated with the onset of this problem
• Loss of feeling and power in the arm
• Sudden onset of pain after trauma

You can take steps to prevent elbow problems from developing in the first place or becoming a recurrent problem:

• Strengthen your forearm muscles. Use light weights or squeeze a tennis ball. Even simple exercises can help your muscles absorb the energy of sudden physical stress.
• Stretch before your activity. Walk or jog for a few minutes to warm up your muscles. Then do gentle stretches before you begin your activity.
• Check your technique. Whatever your sport, ask an instructor to check your technique to avoid overload on muscles.
• Use the right equipment. If you are using older golfing irons, consider upgrading to lighter graphite clubs. If you play tennis, make sure your racket fits you. A racket with a small grip or a heavy head may increase the risk of elbow problems.
• Lift properly. When lifting anything — including free weights — keep your wrist rigid and stable to reduce the force to your elbow.
• Know when to rest. Try not to overuse your elbow. Stop doing activities that cause pain or find another way of doing them that does not cause pain or stress.
• Wear an elbow splint/brace for support when you are using your arm (not while resting or sleeping) to stop further damage to your tendons. Ask a physiotherapist for advice about the best type of brace or splint to use.
• Reduce/ Quit smoking. It is thought smoking could interfere with the circulation to tendons. This means the tendons are at increased risk of injury. If circulation is poor, tendons may take longer to heal or may not heal well. Previous smokers are also at increased risk of tennis elbow due to the previous exposure and effects of tobacco on the vascular system. You can find help to reduce or quit smoking here.
• Weight loss. Being overweight can increase the number inflammatory molecules in the body which can lead to local and systemic inflammation within the body and therefore poorer healing and resolution of pain. To get help with losing weight click here.

The natural course of tennis & golfer’s elbow is improvement and in 80-90% of cases there will be a spontaneous recovery. However, symptoms can take up to 12-18 months to resolve.

Changes in lifestyle and modifying the known causes, as previously explained, can reduce the symptoms getting worse. The best person to manage your symptoms is you.

Avoiding or changing activities

If you have symptoms of tennis or golfer’s elbow, you should stop doing activities that strain the affected muscles and tendons.

If you use your arms at work to carry out manual tasks, such as lifting, you may need to avoid these activities until the pain in your arm improves.

Alternatively, you may be able to change the way you do these types of movements, so they do not place strain on your arm.

Talk to your employer about avoiding or changing activities that could aggravate your arm and make the pain worse.

Ice

Use a cold compress, such as a bag of ice, wrap this in a damp towel and place on the painful area. Leave for 15 minutes, checking the skin regularly. Repeat this 3-4 times per day particularly after activity. If you have any concerns about your circulation or ability to feel this area, then please consult with your GP prior to applying ice to this area.

Painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)

Taking painkillers, such as paracetamol, and NSAIDs, such as ibuprofen, may help ease mild pain and inflammation caused by tennis and golfer’s elbow.

NSAIDs are available as tablets or creams and gels (topical NSAIDs), which are applied directly to the area of your body where there is pain.

Topical NSAIDs are often recommended for musculoskeletal conditions, rather than anti-inflammatory tablets. This is because they can reduce inflammation and pain without causing side effects, such as feeling sick (nausea) and diarrhoea.

NSAIDs may be contra-indicated for certain patients with other underlying health conditions or who are taking certain prescription medicines. A pharmacist will be able to offer advice on whether an NSAID is suitable for you.

Read more about non-prescription and prescription-only medicines

Physiotherapy

Physiotherapists are healthcare professionals who use a variety of methods to restore movement to injured areas of the body. You can often self-refer to an NHS physiotherapist or access one privately. If in doubt your GP surgery will be able to advise/signpost you appropriately.

The physiotherapist may use manual therapy techniques, such as massage and manipulation, to relieve pain and stiffness, and encourage blood flow to your arm. They can also show you exercises you can do to keep your arm mobile and strengthen your forearm muscles.

The use of a brace, strapping, support bandage or splint (called an orthosis) may also be recommended in the short term.

Read more about physiotherapy

Acupuncture

Acupuncture may provide some short-term relief in the treatment of tennis & golfer’s elbow. However, research remains unclear on long term benefits and this treatment is not currently available locally under the NHS.

Steroid injections

Steroid injections are reserved for very resistant cases as they carry significant risks of side-effects and complications, particularly if performed on a repeated basis to the same area (these include infection, changes in skin pigmentation, thinning of the skin, underlying subcutaneous fat and tendon as well as systemic effects such as impairing diabetic control). They are therefore only offered when other treatments have not worked.

Steroid injections may be performed by a GP, a specialist physiotherapist or by a specialist doctor in hospital such as an orthopaedic surgeon.

The injection is given directly into the painful area around the elbow. A local anaesthetic may be given first to numb the area and reduce the pain.

Steroid injections are only likely to give short-term relief and their long-term effectiveness is poor. If they are helping, you may be offered up to 3 injections in the same area, with at least a 3- to 6-month gap between them.

Shockwave therapy

Shockwave therapy is a non-invasive treatment, where high-energy shockwaves are passed through the skin to help relieve pain and promote movement in the affected area.

Research shows that shockwave therapy can help improve the pain in these conditions in some cases but not all, therefore further research is needed.

Under the NHS locally, shockwave therapy is only available in limited cases, when it is thought to be the most appropriate treatment by a hospital specialist.

Surgery

Surgery is rarely warranted for epicondylitis given its self-limiting nature. However, in exceptional cases where the condition is causing severe and persistent pain, surgery may be considered. The damaged part of the tendon will be removed to relieve the painful symptoms.

Useful information about Tennis elbow & Golfer’s elbow:

• What is Tennis Elbow? – University Hospitals Plymouth NHS Trust
• What is Golfer’s Elbow? – University Hospitals Plymouth NHS Trust

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

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