Tennis & golfer's elbow (epicondylitis)

Each of the two is a kind of tendinopathy. The muscles that grip and move the wrist are anchored by tendons to the bony points on either side of the elbow: those that straighten the wrist and fingers on the outer side, those that bend them on the inner side. When a tendon is loaded faster than it can repair, its structure changes and it becomes painful where it meets the bone. The old name epicondylitis suggests inflammation, but in most people the problem is a tendon struggling to keep up, not active inflammation.

The usual trigger is repeated or unaccustomed use of the wrist and forearm: gripping, lifting, twisting, typing, using tools such as a screwdriver, or painting, more often than sport. It is most common between the mid-thirties and mid-fifties, affects men and women alike, and often has no single obvious cause.

Now and then the same pain at the bone comes from inflammation where tendons anchor, called enthesitis, as part of a wider inflammatory condition such as psoriatic arthritis or axial spondyloarthritis. Pain in both elbows, or elbow pain alongside heel pain, back stiffness that eases with movement, psoriasis or a swollen joint, points that way.

The usual symptoms are:

• Soreness over the bony knob on the outside of the elbow (tennis elbow) or the inside (golfer's elbow); where it sits tells the two apart
• Pain on gripping, lifting, shaking hands or opening a jar, and sometimes when straightening the arm fully
• Pain that can spread down the forearm towards the wrist, and a weaker grip

The tender spot at the elbow, and the movements that set the pain off, can usually point to the diagnosis. The examination also looks for what can cause similar pain: a nerve trapped at the elbow or the neck, arthritis of the elbow joint, or an inflammatory cause.

Scanning the elbow with ultrasound in the consultation can show the tendon where it joins the bone, so the problem can often be confirmed at the first visit, and the ultrasound clinic page covers the scan itself.

Treatment usually centres on activity modification, a structured exercise programme to load the tendon appropriately, and pain relief, which helps most people over time. A steroid injection is not currently offered for either condition, reflecting UK guidance: any relief it gives is short-lived, and by six months outcomes are poorer than with no injection at all. The plan is agreed with you.

Within that plan:

• Changing the load. Cutting down on the gripping, lifting and twisting that hurt, without stopping using the arm, and changing how objects are handled at work and at home to take the strain off.
• Exercise. A programme that loads the tendon gradually, building strength over weeks and months, often with a physiotherapist; it is the treatment the guidance recommends, with its clearest benefit over the first months.
• Pain relief. Paracetamol or an anti-inflammatory gel, and ice wrapped in a cloth, can take the edge off; do not smoke while using the gel, and keep away from flames, as it is flammable. Some people find a forearm strap helps.
• When it does not settle. For pain that persists for many months despite all of this, a specialist opinion can review the diagnosis and the other options.

The aim is steady, manageable loading of the tendon while it recovers, not complete rest:

• Space out the heavier gripping and lifting across the day
• Stay active, and keep the shoulder and the rest of the arm working, as our guide to exercise describes
• Avoid forceful gripping and pinching, and heavy vibrating tools, while the tendon settles
• If the pain flares after a busy day, ease back and build up again

Getting better often takes months, yet the outlook is good: most people end up with an arm that works fully and without pain.

Neither condition is dangerous, and most elbow pain is for a GP, a physiotherapist or a booked assessment. A few pictures need more: the lists below, and the paragraph after them, give each its route, among them an elbow hurt in a fall, a knock or a heavy lift, an arm that turns weak or numb out of the blue, heart pain felt in the arm, a hot, swollen elbow, an infection that has become sepsis, and pins and needles down the arm with neck pain.

Treat any of these as a 999 or A&E emergency: call 999 and do not drive yourself to A&E.

• Severe illness with suspected sepsis: a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours
• With a fever or feeling unwell, a rash that does not fade when you press it, a stiff neck with eyes that cannot bear bright light, or skin, lips or tongue turning blue, grey, pale or blotchy, since these can be signs of meningitis or sepsis; on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet
• A joint you cannot put weight on or move, or that has moved out of place, or, after a fall or injury, very bad pain or any tingling or numbness
• After an injury, a crack heard as it happened, or skin around it that has turned blue, grey or cold, since these can be signs of a broken bone
• Sudden weakness or numbness on one side, a drooping face or difficulty speaking, a sudden severe headache, sudden confusion or a seizure, or sudden loss of vision, any of which can be a stroke, even if it stops after a short time, and an arm that has suddenly gone weak or numb, with no fall, lift or injury behind it, is one of these signs
• An eye that suddenly and completely loses its sight
• Lips, mouth, throat or tongue that suddenly swell, a throat that feels tight, very fast breathing or a struggle to breathe or to swallow, skin, tongue or lips turning blue, grey or pale (on black or brown skin this may be easier to see on the palms of the hands or the soles of the feet), becoming suddenly very confused, drowsy or dizzy, or fainting and not being able to be woken, since this can be a severe allergic reaction, anaphylaxis, which can follow a dose of any medicine
• Chest pain that is crushing, tight or like a pressure, that spreads to an arm, the jaw, the neck, the stomach or the back, that comes with breathlessness, sweating, feeling sick or feeling light-headed, or that came on suddenly and does not go away
• Arm pain that comes on suddenly with pressure, heaviness or squeezing across the chest, which can mean a heart attack

Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:

• A joint that is hot and swollen, with a fever or feeling unwell, since an infected joint has to be ruled out at once, at A&E or through NHS 111
• A joint that has become hot and very swollen suddenly, or is worsening quickly, even without a fever, since an infected joint does not always announce itself with one
• Joint pain with a fever, or feeling hot, cold or shivery, or generally unwell, since an infection in or around a joint has to be found the same day
• Arm pain that is brought on by exercise, stress, emotion or the cold, rather than by a particular movement of the arm, and stops within a few minutes of rest, which can mean angina, a sign of a heart problem; NHS 111 will tell you where to be seen
• Pins and needles, or numbness or weakness that has come on gradually, spreading down the arm or into the hand, with neck pain, since a nerve pressed at the neck can cause it, and the spinal cord itself has to be ruled out the same day
• Pins and needles in the arm or hand that do not go away, or an arm or shoulder that has slowly lost its feeling or its strength, with no injury and no neck pain, since a nerve that is being pressed, at the neck or along the arm, has to be found the same day
• Sudden severe pain at the elbow during a heavy lift, perhaps with a snap, then bruising, the biceps bunched higher up the arm or weakness when turning the palm up, or severe arm pain that makes the arm hard to move, short of the first list's signs, because a torn tendon can need early surgery: A&E or an urgent treatment centre, or an urgent GP appointment, the same day

See a GP if the elbow still hurts after two weeks of easing off and the self-care above, or sooner if it is limiting your work or daily life. Tingling or numbness in the hand or fingers that comes and goes, with no injury and no neck pain, which can come from a nerve trapped at the elbow or from carpal tunnel syndrome at the wrist, is for a GP, while an arm that loses its feeling or strength in a moment, with nothing such as a fall, a lift or an injury behind it, or goes numb after an injury, is a matter for the first list. A weaker grip that comes with the elbow pain is usually the tendon's own and is for a GP too; the same-day list means an arm slowly losing strength beyond the grip, or losing its feeling. Night pain together with losing weight without trying, sweats at night or feeling worn out for weeks needs a GP within days; feeling unwell with a fever or shivers instead belongs to the same-day list. Elbow pain with morning stiffness beyond half an hour, back pain that improves with activity, a joint newly swollen but not hot, a finger or toe swollen from end to end, or a new rash needs a GP within days, since an inflammatory arthritis can begin this way; pain in both elbows, elbow pain with heel pain, or elbow pain with psoriasis in you or your family is worth a routine appointment with your GP or a specialist. No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible. An elbow or arm left at an odd angle or bent out of shape after an accident is a 999 or A&E emergency; after a knock or a fall onto the elbow with none of that and none of the first list's signs, NHS 111 can say where you should be seen. If you cannot tell how urgent something is, asking is never a mistake.

Elbow pain that is not settling deserves a proper look, to confirm which tendons are involved and to rule out other causes. If gripping and lifting still hurt, a specialist review, with ultrasound where helpful, can guide treatment.

How is tennis or golfer's elbow confirmed?

Pressing on the elbow usually finds the tender point, and gripping, lifting with the palm down, or bending the wrist against resistance can bring the pain on. The examination also checks for problems that can mimic them, such as a trapped nerve or arthritis of the elbow, and an ultrasound scan during the appointment can show the tendon where it anchors to the bone.

Are the two elbow conditions really different?

They are the same type of problem affecting different tendons. Tennis elbow involves the tendons on the outer side of the elbow, and golfer's elbow those on the inner side; both tend to hurt with gripping, lifting or twisting, so it is where the pain sits that tells them apart. Despite the names, sport is not the main cause, as both usually come from everyday overuse or repeated strain of the forearm.

How long before it settles?

Some settle within a few weeks, but it often takes months. Many people improve within six months to a year with the right exercises and changes to how they use the arm, and progress tends to come in steps.

What helps at home?

Cut down on the gripping, lifting and twisting that hurt rather than resting the arm completely, and do exercises that load the tendon gradually, as a physiotherapist or the Chartered Society of Physiotherapy's videos show. Paracetamol, an anti-inflammatory gel or a cloth-wrapped ice pack can ease the pain meanwhile; the gel can catch fire, so do not smoke or go near a naked flame while using it. Changing how you handle objects at work and at home can take some strain off. If two weeks of this have not eased it, see a GP.

When is a specialist assessment worth having?

It is sensible to seek review when elbow pain is not settling with self-care, when the diagnosis is unclear, or when it is limiting your work or daily activities. A specialist assessment, with ultrasound where helpful, can confirm the cause and rule out other problems. Steroid injections are not currently offered for tennis or golfer's elbow, as UK guidance advises against them. The emphasis instead falls on what the evidence does support: a structured exercise programme, sensible activity changes and good pain control.