Tennis Elbow: Treatment Overview

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Treatment Overview

Tennis elbow treatment is most often successful. The most important part of treatment is tendon rest. A long rest from aggravating activity allows the small tears in the tendon to heal. Depending on how severe your condition is, you may need to rest your tendon for weeks to months. Surgery is a last resort if other treatment isn't helpful.

Initial home treatment

Treatment for tennis elbow works best when it starts as soon as symptoms appear. If your condition is just developing, rest may be all you need. However, in most cases, more treatment is necessary to protect and heal the tendon.

You can treat your tennis elbow by:

• Reducing pain. Use ice for pain during the first 2 to 3 days after the injury. You can also take nonsteroidal anti-inflammatory drugs, including aspirin (such as Bayer), ibuprofen (such as Advil), or naproxen sodium (such as Aleve). Do not give aspirin to anyone younger than 20because of the risk of Reye's syndrome, a serious illness. Acetaminophen (such as Tylenol) can also help with pain.
• Stopping or changing activities that may irritate the tendon. Learn new techniques for certain movements, and use different equipment that may reduce the stress on your forearm muscles.

Wrist and elbow splints can be used in the treatment of tennis elbow. Splints are sometimes helpful for other bone, joint, and tendon problems. But splints have not been shown to help with pain or recovery for tennis elbow injuries.

Ongoing treatment

Over the first months of recovery from tennis elbow, continue with initial treatment and begin:

• Rehabilitation. After tennis elbow pain is gone, you can start a rehabilitation program. This includes special exercises for flexibility and arm muscle strength, and steps to improve overall fitness. You may try:
  • Warm-up exercises for tennis elbow .
  • Stretching exercises for tennis elbow .
  • Strengthening exercises for tennis elbow .
• Wearing a special "counterforce" brace. This strap, worn around your forearm just below the elbow, may spread pressure throughout the arm instead of putting it all on the tendon. With a counterforce brace, you may do some grasping and twisting activities. It won't help, though, if you continue using a poor technique or the wrong equipment that originally caused your tennis elbow. You don't need a health professional's advice before trying a counterforce brace.

Treatment if the condition gets worse or does not improve

The longer you continue activity that harms the tendon after tennis elbow symptoms begin, the longer rehabilitation will take. This ongoing activity can cause severe tendon damage and may ultimately require surgery. If your symptoms are ongoing, your health professional may suggest:

• Corticosteroid injections. This treatment is sometimes used when 6 to 8 weeks of rest and rehabilitation doesn't relieve pain. However, corticosteroids may be harmful to the tendon.² This is usually only a problem after having many injections in the same year.
• Ultrasound therapy. Ultrasound may promote tendon healing and stop pain.
• Surgery, which is seldom used to treat tennis elbow (less than 5% of cases).³ Surgery may be a treatment option if persistent elbow pain doesn't improve after 6 to 12 months of tendon rest and rehabilitation. Surgery usually involves cutting (releasing) the tendon, removing damaged tissue from the tendon, or both. In some cases, tendon tears can be repaired.

What To Think About

Your treatment choices will depend in part on whether elbow pain affects your job or livelihood. It also depends on whether you are willing or able to change habits or activities that are causing your elbow pain.

Non-surgical treatment is usually started if the injury is:

• A result of overuse.
• A sudden (acute) injury that doesn't have large tears in the tendon or other severe damage in the elbow.

Most cases of tennis elbow respond to rest, ice, rehabilitation exercises, pain medicine and splints. This injury does take from 6 months to 12 months to heal. Patience helps.

Surgery is considered as a last resort when all other nonsurgical treatments have failed. You may be referred for surgery if:⁴

• The injury is from a sudden (acute) injury that left large tears in the tendon or other severe damage in the elbow.
• The injury is from chronic overuse and 6 to 12 months of tendon rest and rehabilitation haven't relieved elbow pain. (If the tendon is very weak, surgery may not improve your situation much.)
• Pain continues despite other treatment.
• You have had a corticosteroid shot and it hasn't helped.

Last updated:	February 14, 2007
Author:	Monica Rhodes
Reviewed By:	Martin Gabica, MD - Family Medicine, David Pichora, MD, FRCSC - Orthopedic Surgery
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC