Patient Resources
NHS Lothian MSK Self Help Resources Webpage
Definition
Tennis elbow is a soft tissue problem that causes pain and tenderness at the lateral elbow. It is a tendinopathy of the common extensor origin.
Golfer’s elbow causes pain and tenderness at the medial elbow. It is a tendinopathy affecting the common flexor origin.
Typical signs and symptoms
Tennis elbow:
- Localised tenderness on palpation over the lateral epicondyle or surrounding area.
- Elbow and wrist joint active and passive range of movement is usually preserved.
- Pain +/- weakness on resisted wrist extension and/or middle finger extension.
- Grip strength may be reduced due to pain.
Golfer’s elbow:
- Localised tenderness on palpation over the medial epicondyle or surrounding area.
- Elbow and wrist joint active and passive range of movement is usually preserved.
- Pain +/- weakness on resisted wrist flexion and/or pronation.
- Grip strength may be reduced due to pain.
Prevalence and risk factors
- Tennis elbow is more common than golfer’s elbow.
- Male = female; typically aged 35-54 years.
- Risk factors include: activities, sports or manual occupations that involve loading, repetitive movement or gripping; certain medical conditions and metabolic factors (e.g. high cholesterol, inflammatory conditions, diabetes, obesity), lack of quality sleep, stress, long term and excessive alcohol intake, smoking, genetics, diet and nutrition.
Prognosis/ risks factors for poor outcomes
Tennis elbow and golfer’s elbow are generally self-limiting conditions, and spontaneously improve in about 80–90% of people over 1–2 years.
Risks for poorer outcomes include: higher pain severity and disability at baseline, longer pain duration, multi-site pain, previous pain episodes, anxiety and/or depression, adverse coping strategies, low social support, poor self-efficacy, low expectations of recovery, contributing factors that affect tendon quality e.g. lifestyle – smoking, alcohol, physical activity levels; diabetes, inflammatory conditions, high cholesterol, obesity; occupational stress.
Other considerations
Most cases of tennis elbow and golfer’s elbow resolve spontaneously.
Steroid injections are not recommended; they can help with short-term pain relief however, they can weaken tendons. Research has shown that after one year, people who have had an injection for tennis elbow tend to be worse off than those who have not.
Relevant standards and guidelines
NICE Clinical Knowledge Summaries: Tennis elbow
BESS: Patient Care Pathways and Guidelines
P.A & M.A- 15-7-26
Who can refer:
- All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners
- Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP Where To Find Us – Musculoskeletal Physiotherapy)
- Secondary care consultants and associated teams
- MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes NHS Lothian Integrated Shoulder & Elbow Service
Who and How to refer:
| Condition | Referral Type | Referral destination and process |
|---|---|---|
| Suspected septic arthritis/ septic bursitis | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected facture or dislocation | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute distal biceps rupture | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute traumatic rotator cuff tear in the younger patient | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected malignancy/ tumour specific to shoulder* | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected inflammatory condition | Consider referral to Rheumatology – see RefHelp Rheumatology. | |
| Suspected neurological condition | Consider referral to Neurology – see RefHelp Neurology. |
* Please also see Sarcoma – RefHelp. If clinical assessment leads to a very strong suspicion of suspected underlying malignancy, with no specific localising signs or symptoms to suggest a specific underlying primary, consider recommendations and referral options detailed on GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) – RefHelp
Who not to refer:
- Patients who have the presence of significant red flags/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition – see serious shoulder & elbow conditions
- Age <16
For further information see associated sections
- Link to NHS Lothian patient internet site including patient information resources – https://services.nhslothian.scot/ISES/Pages/default.aspx
- Link to NHS Inform page shoulder problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/shoulder-problems
- Link to NHS Inform shoulder problems- Patient self help guide https://www.nhsinform.scot/self-help-guides/self-help-guide-shoulder-pain
- Link to NHS Inform page elbow problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/elbow-problems
- Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service http://intranet.lothian.scot.nhs.uk/Directory/physiotherapy/NHSLIntegratedShoulderandElbowService/Pages/default.aspx
