Tennis Elbow
Surgery for tennis elbow, a type of elbow tendonitis, should be avoided as recent studies suggest surgery is no better than physiotherapy or sham surgery.
Elbow Tendonitis: The Complete Guide to Tennis Elbow
Tennis elbow, also known as lateral epicondylitis, is the most common elbow tendonitis. It affects the tendon attaching the forearm muscles to the outside of the elbow. Despite the name, it extends far beyond tennis — any activity that stresses the elbow can trigger it, from playing an instrument to using a hammer. A similar injury on the inner side of the elbow is called golfer’s elbow.
Dr Masci treats complex elbow tendonitis at his London clinics as a tendon specialist and has co-authored the published evidence on tendon injections. This guide covers the symptoms, diagnosis, and what genuinely works — including which injections help and which ones harm.
What are the symptoms of elbow tendonitis?
Pain sits on the outside of the elbow. It flares when lifting with the arm, gripping objects such as a cup, or rotating the forearm — turning a door handle is the classic trigger. Severity ranges from a mild nuisance to pain that stops sport and work entirely.
How do we diagnose elbow tendonitis?
History and examination usually suffice. In complex cases, imaging confirms lateral epicondylitis and excludes the mimics. Ultrasound shows the typical tendon changes — thickening and increased blood flow — and allows us to examine the elbow joint and surrounding nerves in a single scan.
Other causes of outer elbow pain include:
- Elbow arthritis
- Radial tunnel syndrome — a trapped nerve that closely mimics tennis elbow
- Referred pain from the neck
Getting the diagnosis right matters because each of these needs different treatment.
What is the best treatment for elbow tendonitis?
Exercise — the evidence is clear that physiotherapy is the most effective treatment for tennis elbow. Daily light-weight exercises strengthen the forearm muscles, supported by nerve stretches and neck mobility work. Improvement builds gradually over weeks to months.
For cases that stall, the ladder continues:
- GTN patches — a non-invasive option trialled for 2–3 months alongside exercise
- Shockwave therapy — 3–5 sessions of sound-wave treatment
- Injections — for the cases that fail everything above
Dr Masci assesses your elbow, confirms the diagnosis with ultrasound, and recommends the right rung of the ladder in a single one-stop visit — matched to your preference for non-invasive or injection-based treatment.
Which injection for elbow tendonitis — and which to avoid?
Avoid cortisone. Cortisone injections harm elbow tendonitis: patients do worse than with no treatment, and one study found cortisone patients behind placebo at 12 months.
The injections that help are needle tenotomy and platelet-rich plasma — our two preferred options, both performed under ultrasound guidance as one-stop visits. Our tennis elbow injection guide compares every option, and our PRP for tennis elbow guide covers the evidence and costs in depth.
What about a tennis elbow tear?
Tears of the extensor carpi radialis tendon commonly develop in longstanding elbow tendonitis. Most are small, sit on the tendon’s undersurface, and need the same treatment as tendonitis — simple measures first, then GTN or shockwave, then needle tenotomy or PRP. Occasionally, the radial collateral ligament beneath the tendon also tears, causing ongoing pain and instability. Surgery is indicated only for rare full-thickness, retracted tears.
Frequently asked questions about elbow tendonitis.
How long does elbow tendonitis take to heal?
Most cases settle within 6–12 months with a consistent exercise programme. Stubborn cases that need shockwave or injections take longer, but the large majority recover without surgery.
Should I have surgery for elbow tendonitis?
No — avoid it. Recent studies show that tennis elbow surgery performs no better than physiotherapy or even sham surgery. Exhaust every conservative option, including injections, first.
Can I keep playing sports with elbow tendonitis?
Often, yes — at modified loads. Reduce the aggravating activity rather than stopping entirely; keep pain at a low level, and build forearm strength alongside. A brace can help you stay active during rehab.
Final word from Sport Doctor London about elbow tendonitis
Elbow tendonitis is a common cause of outer elbow pain — pain with lifting, gripping, and turning, with tenderness where the tendon meets the bone. Simple treatments work for most people: forearm strengthening and nerve stretches first, then GTN patches or shockwave, with needle tenotomy or PRP reserved for complex cases. Skip the cortisone, and avoid surgery.
To book a one-stop elbow tendonitis assessment with Dr Masci in London, contact his team here or call +44 (0) 203 488 0350.