Tennis & golfer's elbow (epicondylitis)

Both conditions are a form of tendinopathy: the tendons that anchor the forearm muscles to the elbow become irritated and gradually change in structure. Despite the older term "epicondylitis", the problem is less about active inflammation and more about a tendon that has been loaded faster than it can repair.

The usual trigger is repeated or unaccustomed strain of the wrist and forearm, from work, hobbies, DIY, gardening or sport, rather than a single injury. It is most common in the forties and fifties and affects men and women equally, particularly where activities involve sustained gripping, lifting or twisting. Often no single cause stands out.

The pattern depends on which side of the elbow is affected. Features may include:

• Pain and tenderness on the outer side of the elbow (tennis elbow) or the inner side (golfer's elbow)
• Pain that is worse with gripping, lifting or twisting movements of the forearm and wrist
• Weakness of grip, or discomfort that radiates down the forearm

These conditions can usually be recognised from the history and examination. Confirming the diagnosis helps rule out other causes of elbow pain and guides treatment.

Ultrasound can show the affected tendons and confirm the problem, as well as helping direct any treatment accurately. Dr Borukhson uses point-of-care ultrasound during the consultation, so the elbow can often be examined in the same visit. You can read more on the ultrasound clinic page.

Treatment usually centres on activity modification, a structured exercise programme to load the tendon appropriately, and pain relief, which helps most people over time. In selected cases an ultrasound-guided injection around the area may be considered, with ultrasound guidance ensuring accurate placement. The plan is agreed with you.

The aim is not complete rest but steady, manageable loading while you let the tendon settle. Adjusting how much you do, rather than stopping altogether, usually works best, and short flares after a busy day are common and not a sign of harm.

• Spread heavier gripping and lifting tasks through the day rather than doing them in one burst
• Keep the rest of the arm and shoulder moving, and stay generally fit, as covered in our guide to exercise
• Where you can, use both hands or a larger, padded grip to ease the strain
• Simple pain relief can make it easier to keep moving

Recovery is often slow and measured in months, but the long-term outlook is good and most people regain full, pain-free use of the arm.

Tennis and golfer's elbow are not dangerous, but a few features point to a different problem and deserve prompt attention. Arrange urgent review if you have:

• Pain following a clear injury or fall, or a sudden inability to use the arm, which may suggest a tear or fracture
• A hot, swollen or red elbow with fever or feeling unwell, as a joint infection needs same-day care
• Pins and needles, numbness or weakness in the hand or fingers, which can indicate a trapped nerve, either the ulnar nerve at the elbow or carpal tunnel syndrome at the wrist, rather than a tendon problem

Seek routine review if the pain is not settling over several weeks despite self-care, the diagnosis is unclear, or it is disturbing sleep or limiting your work and daily activities.

Elbow pain that is not settling is worth assessing to confirm the cause and put in place an effective plan. If you have ongoing pain at the elbow, a specialist review, with ultrasound where helpful, can guide treatment.

How are tennis elbow and golfer's elbow diagnosed?

Both can usually be recognised from your history and an examination, including where the elbow is tender and which movements reproduce the pain. Confirming the diagnosis helps rule out other causes of elbow pain and guides treatment. Ultrasound can show the affected tendons and confirm the problem. Dr Borukhson uses point-of-care ultrasound during the consultation, so the elbow can often be assessed in the same visit.

What is the difference between tennis elbow and golfer's elbow?

They are the same type of problem affecting different tendons. Tennis elbow involves the tendons on the outer side of the elbow and tends to hurt with gripping, lifting or twisting. Golfer's elbow affects the inner side. Despite the names, most people who develop either have never played the sport, as both usually come from everyday overuse or repeated strain of the forearm.

How long does tennis or golfer's elbow take to settle?

Most cases improve with the right approach, though it often takes time and can be slow, sometimes over several months. The mainstay is modifying the activities that aggravate it, a structured exercise programme to load the tendon appropriately, and pain relief. Recovery is rarely instant, but steady progress is the usual pattern. If the pain is not settling, an assessment can confirm the cause and refine the plan.

What can I do at home to help my elbow?

Easing off the movements that trigger the pain, particularly heavy gripping, lifting and twisting, often helps, alongside simple pain relief. Rather than resting completely, a graded exercise programme that gradually loads the tendon tends to give the best results. Small changes to technique or equipment at work or in sport can reduce strain too. If progress stalls, a tailored exercise plan from a specialist or physiotherapist is worthwhile.

When should I see a specialist about elbow pain?

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. In selected cases an ultrasound-guided injection around the area may be considered, with the plan always agreed with you.