Tennis elbow: why it hurts, how long it lasts and what the evidence says about injections

Despite the name, you don’t have to play tennis to get it. Tennis elbow causes pain on the outside of the elbow and, according to the NHS, it is most common between the ages of 35 and 54.^[1]

Why it happens

The NHS links it to inflamed tendons, the cords that connect muscle to bone, from repetitive gripping or twisting of the wrist and forearm. Some examples:^[1]

• Computer work
• Manual tasks such as sewing or using a screwdriver
• Leisure activities such as tennis or playing an instrument

Symptoms

• Pain on the outside of the elbow, which may be worse when lifting or gripping objects, or moving the wrist^[1]
• Tenderness or swelling at the elbow^[1]
• Pain in the forearm^[1]
• Difficulty fully straightening the arm^[1]

How long it lasts

It usually gets better after resting the arm for a few weeks, although it can sometimes last more than a year.^[1]

What to do at home

The NHS recommends:^[1]

• Avoiding or reducing activities that make symptoms worse.
• Applying a hot or cold pack wrapped in a towel, for up to 20 minutes every 2 to 3 hours.
• Doing simple exercises that bend and straighten the arm.
• Using acetaminophen or an anti-inflammatory gel for pain.
• Considering a forearm strap or a wrist or elbow brace from a pharmacy.

If you use ibuprofen gel, don’t smoke or go near flames: it is flammable and can cause severe burns.^[1]

What about steroid injections?

They are one of the best-known options, but the evidence calls for caution. A clinical trial published in JAMA in 2013, with 165 patients who had tennis elbow for more than 6 weeks, compared a corticosteroid injection with a placebo injection. At 1 year, the results were:^[2]

Results at 1 year: corticosteroid vs. placebo injection

CorticosteroidPlacebo

Complete recovery or much improvement

83%96%

Recurrence

54%12%

The authors concluded that the corticosteroid injection led to worse clinical outcomes after 1 year than placebo, with more recurrences. Physiotherapy made no significant difference at 1 year, although, combined with the placebo injection, it did improve results at 4 weeks.^[2]

What the overall evidence says

A 2015 meta-analysis of 22 clinical trials with 2,280 patients compared different non-surgical treatments (injections, physiotherapy, shock wave therapy, laser, ultrasound and others) with observation or placebo. It concluded that they don’t provide a clear clinical benefit in the intermediate to long term compared with observation alone.^[3]

What does that mean in practice? Tennis elbow tends to improve over time, and the goal of treatment is to ease the pain while it heals, without risking a worse outcome.

When to see a doctor

According to the NHS:^[1]

• See a doctor if you still have pain after at least 2 weeks of rest and home care.
• Physiotherapy may be considered if symptoms persist after 6 weeks.
• Surgery is an option if symptoms persist after 6 to 12 months.

If elbow pain isn’t improving or keeps you from working, an assessment can help you choose the treatment that’s right for you, with clear information about what works and what doesn’t.