Clinical Review

The management of tennis elbow

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d2687 (Published 10 May 2011) Cite this as: BMJ 2011;342:d2687

This article has a correction. Please see:

  1. John Orchard, adjunct associate professor1,
  2. Alex Kountouris, physiotherapist2
  1. 1School of Public Health, University of Sydney, NSW 2006, Australia
  2. 2Australian Cricket Team, Melbourne, Australia
  1. Correspondence to: J Orchard johnorchard{at}msn.com.au
  • Accepted 17 April 2011

Summary points

  • Tennis elbow is a tendinopathy of the common extensor origin of the lateral elbow

  • Cortisone injections are harmful in the longer term and are no longer recommended in most cases

  • Rehabilitation (exercise) based treatment is helpful, but to be effective patients must usually remove tendon overload

  • Further research is needed on newer (minimally invasive) treatments, such as platelet-rich plasma injections, hyaluronan gel injections, and nitrate patches

  • Reserve surgery and botulinum toxin injections for the worst cases because patients can take six months to return to full function

  • Many cases of tennis elbow cases will naturally resolve in 6-12 months

Tennis elbow is a tendinopathy of the common extensor origin (fig 1) of the lateral elbow. Although the pathology is in the elbow region, patients present with gradual onset of pain on extension movements of the wrist and fingers and supination of the forearm. The condition was formerly known as “lateral epicondylitis.” Because the pathology is no longer thought to be inflammatory, the “itis” suffix is a misnomer,1 2 and it is more accurately described as a partially reversible but degenerative overuse-underuse tendinopathy. Because of the length of this term, most clinicians prefer to use the informal name “tennis elbow.” The condition is usually easy to diagnose on clinical presentation (imaging is rarely needed to exclude coexisting elbow joint pathology) but much harder to cure. The clinical features are tenderness at the lateral epicondyle, normal elbow range of motion, and pain on resisted movements (particularly resisted third finger extension). If the elbow’s range of motion is restricted, other diagnoses should be considered because the loss of range suggests joint pathology.

Sources and selection criteria

We performed a search of PubMed and SPORTDiscus for the terms “tennis elbow” and “lateral epicondl*” and extracted what we thought were the most valid reviews and trials of …

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