The elbow plays a crucial role in upper limb movement, contributing to the strength, stability, and flexibility required for daily tasks. Whether lifting, twisting the forearm, or gripping objects, the coordinated action of the elbow joint and its surrounding muscles enables smooth and functional movement.
Tennis elbow, medically known as lateral epicondylitis, is a condition characterised by pain and tenderness on the outer aspect of the elbow.
It occurs when the tendons that attach the forearm muscles to the lateral epicondyle (the bony prominence on the outside of the elbow) become inflamed or degenerate due to overuse. The discomfort is often aggravated by gripping, lifting, or repetitive wrist extension.
Despite its name, tennis elbow is not limited to tennis players. While it is common in racquet sport athletes, it can affect anyone whose occupation or activities involve repetitive movements of the forearm, such as manual labourers, painters, carpenters, or individuals who spend prolonged periods using a computer mouse or keyboard.
Tennis elbow is a painful condition caused by overuse of the forearm tendons that attach to the outer part of the elbow.
What causes tennis elbow?
Tennis elbow develops when the tendons that attach the forearm muscles to the lateral epicondyle of the elbow become overloaded. This overuse often leads to small tears in the tendon, resulting in inflammation, pain, and reduced function over time. While the condition is commonly associated with racquet sports, it can occur in a wide range of occupations and activities involving repetitive arm and wrist motion.
Common contributing factors include:
Repetitive movements — continuous gripping, twisting, or lifting, especially with the wrist extended, places strain on the forearm extensor tendons. These activities are typical in sports, manual labour, and certain hobbies.
Improper technique or ergonomics — poor posture, incorrect technique during sports or work-related tasks, or using tools that are not well-suited to the hand can increase mechanical stress on the elbow. Inadequate warm-up or stretching before activity may further increase risk.
Unaccustomed activity — sudden increases in activity intensity or duration, such as starting a new workout routine, gardening for prolonged periods, or undertaking DIY tasks, can overload the tendon.
Age-related degeneration — most cases occur in individuals between the ages of 35 and 50. With age, tendons naturally lose some of their elasticity and ability to repair, making them more vulnerable to injury.
Occupational risk — jobs that involve repetitive hand and wrist motions, such as carpentry, plumbing, painting, typing, or cooking, can predispose individuals to developing tennis elbow.
Vibration exposure — frequent use of vibrating tools, such as drills or power sanders, can also contribute to tendon strain.
Although it is a localised condition, tennis elbow often reflects a mismatch between tendon load and recovery. Early recognition and adjustment of activity levels are key to preventing progression.
What are the symptoms of tennis elbow?
Tennis elbow may cause pain and tenderness on the outer part of the elbow, which can radiate down the forearm during movement or gripping.
Tennis elbow typically presents with a combination of pain, weakness, and reduced function in the arm. The symptoms may develop gradually and often worsen with continued use of the affected arm, especially during tasks that involve gripping or wrist extension.
Common signs and symptoms include:
Pain or tenderness over the outer part of the elbow (lateral epicondyle)
Discomfort that may radiate down the forearm towards the wrist
A weakened grip, especially when holding objects like a mug, tool, or racquet
A burning or sharp sensation around the elbow, particularly during movement
Stiffness or reduced range of motion in the elbow
Mild swelling around the joint
Difficulty fully straightening or extending the arm
These symptoms are typically aggravated by certain everyday actions, such as:
Gripping items firmly (e.g., holding a racquet, or shaking hands)
Lifting or carrying objects, especially with the palm facing downward
Opening jars or turning doorknobs
Raising the hand or bending the wrist backwards
Repetitive typing or use of a computer mouse
Symptoms may initially appear mild but can worsen over time without appropriate rest or treatment.
Who is at risk of developing tennis elbow in Singapore?
While tennis elbow is not exceedingly common in Singapore, certain individuals are more likely to develop the condition due to lifestyle, physical activity, or biological factors. Understanding these risk factors can help identify those who may benefit from early preventive strategies.
Key risk groups include:
Adults aged 40 to 60 — although tennis elbow can affect individuals of any age, it is more frequently seen in middle-aged adults, particularly those engaged in physical or repetitive work.
Athletes — those who participate in sports involving repeated arm movements, such as tennis, squash, badminton, golf, and throwing sports are at higher risk due to the strain placed on the forearm tendons.
Occupational risk — jobs that require repetitive hand, wrist, or forearm motions significantly increase the likelihood of tendon overuse. This includes carpenters, plumbers, chefs, butchers, manicurists, painters, and mechanics.
Individuals with higher BMI — obesity is associated with increased mechanical stress on joints and tendons, which may impair tendon healing and raise the risk of overuse injuries.
Smokers — smoking adversely affects blood flow and tissue repair, compromising tendon health and making recovery from repetitive strain slower and less effective.
How is tennis elbow diagnosed?
Tennis elbow is primarily diagnosed through a detailed clinical assessment. Your doctor will begin by reviewing your symptoms, medical history, and any activities that may have contributed to the pain. The goal is to determine whether the discomfort stems from the outer elbow tendons or another underlying issue.
During the physical examination, the doctor will:
Palpate the outer part of the elbow to assess for tenderness
Ask you to perform specific movements, such as extending your wrist or fingers against resistance, to reproduce pain
Evaluate the range of motion in your elbow, wrist, and shoulder
Check for signs of nerve involvement or other joint conditions
In most cases, a clinical examination is sufficient to confirm the diagnosis. However, if symptoms are severe, persistent, or atypical, additional tests may be recommended to rule out other conditions:
Ultrasound — can detect tendon tears, inflammation, or degeneration
Magnetic Resonance Imaging (MRI) — may be used if the diagnosis is uncertain or if other joint or nerve conditions are suspected
X-rays — generally not required for diagnosing tennis elbow but may help exclude other causes of elbow pain, such as fractures, sprains or arthritis.
What are the treatment options for tennis elbow in Singapore?
The treatment approach for tennis elbow depends on the severity of symptoms and how the condition has progressed. Most cases respond well to non-surgical measures, particularly when addressed early. However, in more persistent or severe cases, surgical options may be considered.
For mild to moderate cases, non-invasive interventions are usually effective. These may include:
Rest and activity modification — avoiding activities that strain the forearm tendons gives the tissue time to recover. Simple adjustments to daily tasks can help prevent further irritation.
Bracing or elbow straps — a counterforce brace worn just below the elbow can reduce stress on the affected tendon during movement, promoting healing.
Ice application — applying cold packs to the outer elbow helps reduce inflammation and provides short-term pain relief, particularly after activity.
Pain relief medication — non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to relieve pain and inflammation.
Physiotherapy — a structured physiotherapy programme can be highly effective. This includes exercises to strengthen the forearm muscles, improve flexibility, and support tendon recovery.
If symptoms persist despite conservative management for six to twelve months, surgery may be advised to address underlying tendon damage. Surgical options include:
Both procedures may be performed through open surgery or minimally invasive techniques, depending on the individual case.
Rehabilitation plays a vital role in long-term recovery, whether treatment is conservative or surgical. It helps restore strength, prevent stiffness, and reduce the risk of recurrence. Key components of rehabilitation often include:
Range of motion exercises — gentle stretches to maintain flexibility in the elbow and wrist.
Strengthening exercises — focused on improving muscle support around the forearm and wrist to offload stress from the tendons.
Gradual return to activity — a phased approach to resuming normal work or sport ensures that the elbow adapts progressively without reinjury.
With appropriate treatment and commitment to rehabilitation, most individuals make a full recovery and regain pain-free function in the affected arm.
Bracing or elbow straps can help relieve tennis elbow symptoms by reducing strain on the affected tendons during movement.
Summary
Tennis elbow, or lateral epicondylitis, is a common overuse injury affecting the tendons on the outer part of the elbow, typically caused by repetitive wrist and forearm movements. It often presents with pain, weakness, and difficulty performing everyday tasks such as gripping or lifting. While it is frequently seen in athletes and manual workers, anyone engaged in repetitive arm activity may be at risk.
Diagnosis is usually based on clinical examination, with imaging used in persistent or unclear cases. Most cases respond well to conservative treatments such as rest, physiotherapy, bracing, and medication, though surgery may be required for more severe or prolonged symptoms. A structured rehabilitation plan is essential for full recovery and preventing recurrence.
If you are experiencing persistent elbow pain or suspect you may have tennis elbow, schedule a consultation with Cove Orthopaedics for a personalised assessment and personalised treatment plan.
Frequently asked questions
Yes, cubital tunnel syndrome can cause pain, particularly on the inner side of the elbow. Many individuals experience a dull ache, sharp pain or burning sensation that may extend down to the forearm, and into the hand. Occasionally, the discomfort worsens with prolonged elbow bending, such as when using a phone or driving.
Delaying treatment for cubital tunnel syndrome can lead to progressive nerve damage, resulting in persistent numbness, muscle weakness, and even muscle atrophy in the hand. Additionally, severe cases may cause difficulty in gripping objects or performing fine motor tasks, making everyday activities challenging.
Mild cases of cubital tunnel syndrome may improve with rest, activity modification, and ergonomic adjustments. However, if symptoms persist or worsen, medical treatment may be required to prevent further nerve compression, and long-term dysfunction.
While not all cases of cubital tunnel syndrome are preventable, you can reduce the risk by:
Avoiding prolonged elbow bending.
Maintaining good posture to minimise nerve compression.
Performing gentle stretching, and strengthening exercises to support nerve mobility.
Using elbow padding to protect against excessive pressure.
Recovery time depends on the severity of the condition, and the chosen treatment approach.
Mild to moderate cases often improve within a few weeks to months with conservative treatments like rest, splinting, and physical therapy.
Severe cases requiring surgery may take several months for full recovery, with improvements seen gradually over time.
Some of the noticeable signs that your treatment is effective include:
Decreased discomfort with daily activities like typing, holding a phone, or sleeping.
Improved grip strength, and hand coordination.
Less numbness, and better sensation in the affected fingers.
Reduced pain, and tingling in the elbow, forearm, and fingers.
Yes, cubital tunnel syndrome can recur, especially if underlying risk factors, such as repetitive elbow bending or prolonged pressure on the ulnar nerve, are not addressed. To minimise recurrence, it is important to follow preventive measures, including ergonomic adjustments, strengthening exercises, and proper posture.
At Cove Orthopaedic Clinic, our utmost importance is in helping our patients maintain or regain the mobility that they deserve, all through excellent patient care right from the start.
Happy and satisfied patients are what keeps us going!
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If you have further enquiries or would like to make an appointment at Cove Orthopaedic Clinic, simply fill in the form below or call us at +65 9631 7637.
