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Practice Practice Pointer

Management of lateral epicondylitis (tennis elbow)

BMJ 2023; 381 doi: (Published 18 May 2023) Cite this as: BMJ 2023;381:e072574
  1. Marta Karbowiak, CT2 in trauma and orthopaedics1,
  2. Thomas Holme, upper limb fellow2,
  3. James Thambyrajah, general practitioner3,
  4. Livio Di Mascio, consultant in trauma in orthopaedics2
  1. 1Portsmouth Hospitals NHS Trust, Portsmouth, UK
  2. 2Royal London Hospital/Barts Health NHS Trust, London, UK
  3. 3Cheam Family Practice, London, UK
  1. Correspondence to M Karbowiak mkarbowiak{at}

What you need to know

  • Symptoms of lateral epicondylitis usually resolve within one year with activity modification and watchful waiting

  • Current evidence suggests that steroid injections do not offer long term benefit

  • Secondary care management may include percutaneous needle fenestration or injections of autologous blood or platelet rich plasma; however, evidence of moderate certainty shows no benefit from these treatments

  • Surgical management in refractory cases usually involves open or arthroscopic release of the affected muscle tendon

Lateral epicondylitis (also known as tennis elbow) is a common, often debilitating disorder frequently encountered in primary care across low and high resource settings.12 This article outlines current management strategies, including supportive measures, activity modification, and newer treatments that have emerged over the past 20 years, such as percutaneous needle fenestration and injection of autologous blood and platelet rich plasma.

What is lateral epicondylitis?

Lateral epicondylitis is a type of tendinosis, a degenerative process where repetitive stress causes fibroblast deposition with collagen disorganisation and vascular hyperplasia.3 Pain causes underuse of the affected arm and further weakening in the tendon structure, with possible sequelae of partial or complete rupture of the tendon.4 Cadaveric and electromyographic studies show that symptoms (namely, lateral elbow pain) are often related to excessive loading of the lateral extensor tendons, as well as repetitive wrist extension or supination movements.5 The condition commonly presents as a work related strain injury, and often affects tennis players6 (box 1).

Box 1

Who gets it?

  • Incidence of lateral epicondylitis is 1.5 to 2.4 cases per 1000 people, according to research from the US.17 Most population studies have been carried out in high resource settings.

  • Occupational exposure can predispose to development of tendinopathy.8 Lateral epicondylitis is more prevalent in people whose profession involves manual work, with a particular link to forceful or repetitive movements.

  • Incidence is higher in people of …

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