Tennis Elbow

 

Introduction

Tennis elbow, also known as lateral epicondylitis, is a condition that affects many individuals beyond those who play tennis. It occurs due to strain or irritation of the tendons that attach to the outer side of the elbow. This condition can lead to discomfort, weakness, and difficulty with everyday activities such as gripping, lifting, or even shaking hands.

Although it is commonly associated with racquet sports, tennis elbow can arise in people whose work or hobbies involve repetitive arm and wrist movements, such as typing, painting, or manual labour. At Joint Injections, we provide personalised approaches to help manage this condition, including the option of ultrasound-guided steroid injections.

Anatomy of the Elbow

To understand tennis elbow, it is useful to explore the anatomy of the elbow. The elbow joint is a hinge joint formed by three bones:

  • The humerus (upper arm bone)
  • The radius (one of the forearm bones)
  • The ulna (the other forearm bone)

On the outer part of the elbow, there is a bony prominence known as the lateral epicondyle. The tendons of the forearm extensor muscles attach here, particularly the extensor carpi radialis brevis (ECRB). These muscles are responsible for straightening the wrist and fingers.

In tennis elbow, the tendon fibres near the lateral epicondyle undergo microscopic damage due to repetitive stress, which can result in pain and functional limitations.

Pathology of Tennis Elbow

Tennis elbow is not primarily an inflammatory condition, even though the suffix -itis suggests inflammation. Instead, it is considered a tendinopathy, where the tendon tissue shows degeneration, microscopic tears, and disorganised collagen fibres.

Key features of the pathology include:

  • Microtears in the tendon fibres
  • Collagen disruption, leading to weakened tissue
  • Increased sensitivity of local pain receptors
  • In some cases, the presence of tiny blood vessel ingrowth around the tendon

These changes explain why repetitive use of the forearm muscles can trigger symptoms and why recovery often requires addressing both the pain and the underlying tendon stress.

Causes and Risk Factors

Tennis elbow can affect anyone, although certain activities make it more likely. Common causes and risk factors include:

  • Repetitive wrist extension and gripping movements
  • Racquet sports (especially with poor technique or unsuitable equipment)
  • Occupational strain, such as in carpenters, painters, or typists
  • Age, typically between 30 and 50 years
  • Sudden overuse, such as increasing activity levels without gradual progression

Symptoms of Tennis Elbow

The hallmark symptoms include:

  • Pain on the outer side of the elbow
  • Discomfort radiating into the forearm or wrist
  • Pain during gripping, lifting, or twisting activities
  • Weakness in grip strength
  • Tenderness over the lateral epicondyle

Symptoms often develop gradually and may worsen with continued activity.

Diagnosis

Diagnosis of tennis elbow is usually clinical, meaning it relies on history and physical examination. A clinician may:

  • Palpate the lateral epicondyle to identify tenderness.
  • Ask the patient to perform resisted wrist extension or gripping, which often reproduces the pain
  • Assess range of motion and rule out other elbow conditions

Imaging techniques may also be used:

  • Ultrasound scanning can detect tendon thickening, tears, or vascular changes

Management Approaches

There are several approaches to managing tennis elbow, ranging from conservative measures to interventional options.

Conservative strategies may include:

  • Rest and activity modification
  • Application of ice
  • Manual therapy and stretching

When symptoms persist, clinicians may recommend interventional treatments.

Ultrasound-Guided Steroid Injections at Joint Injections

At Joint Injections, we offer ultrasound-guided steroid injections as an option for managing tennis elbow.

The use of ultrasound ensures that the clinician can:

  • Visualise the tendon and surrounding structures in real-time
  • Deliver the injection precisely at the site of tendon involvement
  • Minimise the risk of injury to nearby tissues

Steroid injections may help reduce tendon irritation and provide relief from pain, making it easier for individuals to engage in rehabilitation exercises. This can be particularly beneficial for those whose symptoms interfere with work, sports, or daily activities.

Mechanism of Action of Steroid Injections

Steroid injections work by:

  • Reducing local sensitivity of pain receptors
  • Modulating chemical mediators that contribute to tendon irritation
  • By targeting the affected area with ultrasound guidance, clinicians can ensure greater precision compared to landmark-guided techniques.

Why Choose Joint Injections

At Joint Injections, our clinicians use a personalised and careful approach to managing tennis elbow. The key aspects include:

  • Ultrasound guidance for accurate injection delivery
  • Experienced clinicians with expertise in musculoskeletal interventions
  • Tailored treatment plans, considering each individual’s lifestyle and needs
  • A focus on integrating injections with rehabilitation and exercise to support recovery

Living with Tennis Elbow

Living with tennis elbow can be challenging, especially when it interferes with simple daily activities. However, with a combination of activity modification, targeted exercises, and where appropriate, ultrasound-guided steroid injections, many individuals can find a pathway towards improved function.

Early recognition and professional assessment can make a difference in managing symptoms effectively and avoiding prolonged discomfort.

Conclusion

Tennis elbow is a common condition that affects not only athletes but also individuals engaged in repetitive occupational or recreational activities. It involves irritation and microscopic damage to the tendons that attach to the outer elbow.

At Joint Injections, we provide ultrasound-guided steroid injections as part of a wider approach to managing tennis elbow. With careful assessment, targeted treatment, and ongoing support, our aim is to help individuals navigate their symptoms and restore confidence in movement.

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