Tennis Elbow Treatment in Singapore

Tennis elbow, also known as lateral epicondylitis, is a condition characterised by pain and inflammation around the outer part of the elbow. It occurs when the tendons that join the forearm muscles to the outside of the elbow become damaged from overuse. Despite its name, this condition affects many people who never play tennis. The condition can cause pain when performing everyday activities such as gripping objects, turning doorknobs, or shaking hands.

Dr Chong Xue Ling
Dr Chong Xue Ling
Senior Consultant Orthopaedic Surgeon

Symptoms of Tennis Elbow

Tennis elbow presents with several recognisable symptoms that typically develop gradually over time and may worsen without proper treatment.

Pain on the outside of the elbow

Pain typically radiates from the outer part of the elbow down into the forearm and wrist. This pain may occur during activities that use these muscles.

Weakened grip strength

Many individuals experience difficulty in gripping objects or find their grip has become weaker. This weakness can make simple tasks like holding a cup or turning a key challenging.

Pain when lifting or bending

Activities that involve lifting objects, bending the arm, or straightening the wrist often trigger or intensify the pain. This includes actions like pouring from a kettle or lifting groceries.

Morning stiffness

The affected elbow may feel stiff upon waking up. This stiffness typically improves with gentle movement throughout the day.

Pain when extending the wrist

Activities that require extending the wrist against resistance often cause discomfort. This includes actions like using a computer mouse or turning a screwdriver.

Causes and Risk Factors

Tennis elbow develops primarily due to repetitive movements and overuse of the forearm muscles, which can lead to small tears in the tendons.

Repetitive activities

Any activity that involves repetitive wrist and arm movements can lead to tennis elbow. This includes painting, plumbing, carpentry, typing, and using scissors.

Age

People between 30 and 50 years of age are more commonly affected by tennis elbow. The tendons become less flexible and more prone to injury with age.

Occupation-related stress

Certain professions that require repetitive arm movements put individuals at higher risk. These include plumbers, painters, carpenters, butchers, and cooks.

Improper sports technique

Using improper technique during activities like tennis, badminton, or squash can put extra stress on the elbow tendons. This includes using a racquet that is too heavy or has strings that are too tight.

Previous injury

Having a previous injury to the elbow area may increase the likelihood of developing tennis elbow. This includes fractures, sprains, or direct trauma to the area.

Diagnostic Methods

  • Physical examination: The doctor will check for pain areas and assess arm strength and mobility. The examination typically involves applying pressure to the affected area and asking the patient to move their wrist and elbow against resistance to reproduce symptoms.
  • Medical history review: Providing details about occupation, activities, and when symptoms began helps identify potential causes. The doctor will ask about specific movements that cause pain and previous treatments that have been tried.
  • Imaging tests: X-rays can rule out arthritis or bone fractures, while MRI or ultrasound scans can show tendon damage. These imaging studies are particularly useful in chronic cases to assess the extent of tendon degeneration or to identify other elbow pathologies.

Treatment Options

Treatment for tennis elbow aims to reduce pain, promote healing, and strengthen the affected area to prevent recurrence and restore function.

Rest and activity modification: Avoiding activities that worsen symptoms allows the tendons to heal. This does not mean complete immobilisation but rather avoiding movements that trigger pain while maintaining general activity levels.

Ice therapy: Applying ice to the affected area for 15-20 minutes several times daily reduces inflammation. Ice should be wrapped in a thin cloth rather than applied directly to the skin to prevent cold injury.

Physiotherapy exercises: Specific stretching and strengthening exercises help rebuild tendon strength and flexibility. A physiotherapist can design a progressive programme that gradually increases in intensity as the condition improves.

Braces or supports: Tennis elbow straps or braces reduce strain on the injured tendon during activities. These work by redirecting forces away from the damaged tendon and can be particularly helpful during recovery when returning to work or sports.

Anti-inflammatory medications: Over-the-counter medications like ibuprofen can help manage pain and reduce inflammation. These medications should be taken as directed and not used as a long-term solution without medical advice.

Corticosteroid injections: For persistent pain, a corticosteroid injection into the painful area may provide temporary relief. The effects typically last between 4-12 weeks, but repeated injections may cause tissue weakening.

Open surgery: The surgeon makes an incision over the elbow to remove damaged tendon tissue and repair the healthy portion. This traditional approach allows direct visualisation of the damaged area but requires a longer recovery period.

Arthroscopic surgery: Using small incisions and a camera, the surgeon removes damaged tissue with specialised instruments. This minimally invasive approach typically results in less post-operative pain and faster recovery than open surgery.

Percutaneous tenotomy: This minimally invasive procedure involves using a needle to break up scar tissue without open surgery. A special needle is inserted through the skin to disrupt the damaged tissue, promoting healing with minimal trauma to surrounding tissues.

Prevention and Management

Tennis elbow can often be prevented by using proper techniques during sports and work activities, taking regular breaks during repetitive tasks, and performing forearm strengthening exercises regularly. When using tools or sports equipment, ensure they are the correct size and weight for your body. Before engaging in activities that use the forearm muscles, warm up properly with gentle stretches. If early symptoms appear, rest the affected arm and apply ice to prevent the condition from worsening. For those who have experienced tennis elbow before, maintaining a regular schedule of forearm exercises even after recovery can help prevent recurrence.

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Dr Chong Xue Ling

Dr Chong Xue Ling

Senior Consultant Orthopaedic Surgeon

Dr Chong Xue Ling is a Swiss fellowship-trained orthopaedic surgeon specialising in foot and ankle, as well as shoulder and elbow surgery.

She is a member of the European Group for the Study and Research of Minimally Invasive Surgery of the Foot and Ankle. For shoulder and elbow surgery, she completed her fellowship at La Tour Hospital, an accredited Swiss Olympic Medical Centre and learnt innovative techniques in arthroplasty for earlier return to activity as well as the stabilising techniques, developed to have greater strength without extensive fixation.

  • MBBS (S’pore)
  • MRCS (Ireland)
  • MMed Orthopaedic (S’pore)
  • FRCS Orthopaedic (Edinburgh)

Through active involvement in research, she aims to constantly improve existing treatment in the pursuit of quality care for her patients.

Read Full Bio

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    Tennis Elbow

    Frequently Asked
    Questions

    How long does tennis elbow typically take to heal?

    The healing time varies depending on severity and individual factors. Mild cases may improve within 6-8 weeks with proper rest and treatment, while chronic cases can take 6 months or longer to resolve completely.

    Can I continue playing sports with tennis elbow?

    It is generally advised to avoid activities that cause pain until symptoms improve. Once pain subsides, a gradual return to sports with modified technique and proper equipment is recommended.

    Can tennis elbow come back after treatment?

    Yes, tennis elbow can recur, particularly if the underlying causes are not addressed. Maintaining proper techniques and continuing strengthening exercises can help prevent recurrence.