{"id":14456,"date":"2023-03-13T15:51:17","date_gmt":"2023-03-13T15:51:17","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=14456"},"modified":"2026-07-16T11:00:26","modified_gmt":"2026-07-16T10:00:26","slug":"tennis-elbow-golfers-elbow","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/tennis-elbow-golfers-elbow\/","title":{"rendered":"Tennis elbow\/golfers elbow"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Patient Resources<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/self-help-information\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian MSK Self Help Resources Webpage<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.edinburghorthopaedics.org\/patient-information-pages\/elbow\/\" target=\"_blank\" rel=\"noreferrer noopener\">Edinburgh Orthopaedics<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Definition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Tennis elbow is a soft tissue problem that causes pain and tenderness at the lateral elbow.&nbsp; It is a tendinopathy of the common extensor origin.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Golfer\u2019s elbow causes pain and tenderness at the medial elbow. It is a tendinopathy affecting the common flexor origin.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Typical signs and symptoms<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Tennis elbow:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Localised tenderness on palpation over the lateral epicondyle or surrounding area.<\/li>\n\n\n\n<li>Elbow and wrist joint active and passive range of movement is usually preserved.&nbsp;<\/li>\n\n\n\n<li>Pain +\/- weakness on resisted wrist extension and\/or middle finger extension.&nbsp;<\/li>\n\n\n\n<li>Grip strength may be reduced due to pain.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Golfer\u2019s elbow:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Localised tenderness on palpation over the medial epicondyle or surrounding area.<\/li>\n\n\n\n<li>Elbow and wrist joint active and passive range of movement is usually preserved.&nbsp;<\/li>\n\n\n\n<li>Pain +\/- weakness on resisted wrist flexion and\/or pronation.<\/li>\n\n\n\n<li>Grip strength may be reduced due to pain.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Prevalence and risk factors<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tennis elbow is more common than golfer\u2019s elbow.<\/li>\n\n\n\n<li>Male = female; typically aged 35-54 years.<\/li>\n\n\n\n<li>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.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Prognosis\/ risks factors for poor outcomes<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Tennis elbow and golfer\u2019s elbow are generally&nbsp;self-limiting conditions, and spontaneously improve in about 80\u201390% of people over 1\u20132 years.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 &#8211; smoking, alcohol, physical activity levels; diabetes, inflammatory conditions, high cholesterol, obesity; occupational stress.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Other considerations<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Most cases of tennis elbow and golfer\u2019s elbow resolve spontaneously.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Steroid injections are not recommended<\/strong>; 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Relevant standards and guidelines<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/cks.nice.org.uk\/topics\/tennis-elbow\/#!diagnosissub\" target=\"_blank\" rel=\"noreferrer noopener\">NICE Clinical Knowledge Summaries: Tennis elbow<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/bess.ac.uk\/patient-care-pathways-and-guidelines\/\" target=\"_blank\" rel=\"noreferrer noopener\">BESS: Patient Care Pathways and Guidelines<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><strong>P.A &amp; M.A- 15-7-26<\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer: <\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners <\/li>\n\n\n\n<li>Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP <a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/where-to-find-us\/\" target=\"_blank\" rel=\"noreferrer noopener\">Where To Find Us \u2013 Musculoskeletal Physiotherapy<\/a>)<\/li>\n\n\n\n<li>Secondary care consultants and associated teams<\/li>\n\n\n\n<li>MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes <a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Integrated Shoulder &amp; Elbow Service<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who and How to refer:<\/h4>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><thead><tr><th>Condition<\/th><th>Referral Type<\/th><th>Referral destination and process<\/th><\/tr><\/thead><tbody><tr><td><strong>Suspected septic arthritis\/ septic bursitis<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected facture or dislocation<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected acute distal biceps rupture<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected acute traumatic rotator cuff tear in the younger patient<\/strong><\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow &amp; Shoulder<\/td><\/tr><tr><td><strong>Suspected malignancy\/ tumour specific to shoulder*<\/strong><\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow &amp; Shoulder<\/td><\/tr><tr><td><strong>Suspected inflammatory condition<\/strong><\/td><td>&nbsp;<\/td><td>Consider referral to <strong>Rheumatology<\/strong> \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Rheumatology.<\/a><\/td><\/tr><tr><td><strong>Suspected neurological condition<\/strong><\/td><td>&nbsp;<\/td><td>Consider referral to <strong>Neurology<\/strong> \u2013 see&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Neurology.<\/a><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">* <em>Please also see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/\" target=\"_blank\" rel=\"noreferrer noopener\">Sarcoma \u2013 RefHelp<\/a>. 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&nbsp;detailed on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) \u2013 RefHelp<\/a><\/em><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients who have the presence of significant red flags\/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition &#8211; see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/\" target=\"_blank\" rel=\"noreferrer noopener\">serious shoulder &amp; elbow conditions<\/a><\/li>\n\n\n\n<li>Age &lt;16<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">For further information see associated sections<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>Link to NHS Lothian patient internet site including patient information resources \u2013&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/ises\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/ISES\/Pages\/default.aspx<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page shoulder &nbsp;problems&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/shoulder-problems\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/shoulder-problems<\/a><\/li>\n\n\n\n<li>Link to NHS Inform shoulder problems- Patient self help guide&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/self-help-guides\/self-help-guide-shoulder-pain\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/self-help-guides\/self-help-guide-shoulder-pain<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page elbow problems&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/elbow-problems\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/elbow-problems<\/a><\/li>\n\n\n\n<li>Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service&nbsp;<a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Patient Resources NHS Lothian MSK Self Help Resources Webpage Edinburgh Orthopaedics Definition Tennis elbow is a soft tissue problem that causes pain and tenderness at the lateral elbow.&nbsp; It is a tendinopathy of the common extensor origin.&nbsp; Golfer&rsquo;s elbow causes pain and tenderness at the medial elbow. It is a tendinopathy affecting the common flexor<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4425,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1409,905],"class_list":["post-14456","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-elbow-conditions","category-https-apps-nhslothian-scot-refhelp-tennis-elbow-golfers-elbow"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/shoulder-elbow\/https-apps-nhslothian-scot-refhelp-elbow-conditions\/\" rel=\"tag\">Elbow conditions<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/shoulder-elbow\/https-apps-nhslothian-scot-refhelp-elbow-conditions\/https-apps-nhslothian-scot-refhelp-tennis-elbow-golfers-elbow\/\" rel=\"tag\">Tennis elbow\/golfers elbow<\/a>","rttpg_excerpt":"Patient Resources NHS Lothian MSK Self Help Resources Webpage Edinburgh Orthopaedics Definition Tennis elbow is a soft tissue problem that causes pain and tenderness at the lateral elbow.&nbsp; It is a tendinopathy of the common extensor origin.&nbsp; Golfer&rsquo;s elbow causes pain and tenderness at the medial elbow. It is a tendinopathy affecting the common flexor","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14456","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=14456"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14456\/revisions"}],"predecessor-version":[{"id":28979,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14456\/revisions\/28979"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4425"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=14456"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=14456"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}