Tennis Elbow Treatment
In Singapore

Tennis elbow can significantly impact your daily activities, making simple tasks like gripping a coffee cup or shaking hands uncomfortable. At our clinic, we understand how this persistent elbow pain affects your work, sports activities, and quality of life. Our Senior Consultant orthopaedic surgeon specialises in diagnosing and treating tennis elbow using evidence-based approaches tailored to your specific needs and lifestyle demands.

Dr Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus)MMed (SG)MRCS (Glasgow)FRCSEd (Orth)

Causes & Risks Symptoms When to see a Doctor Diagnosis Treatment Complications Prevention FAQ Conclusion

What is Tennis Elbow?

Tennis elbow, medically known as lateral epicondylitis, is a painful condition affecting the tendons that attach to the outer part of your elbow. Despite its name, this condition affects more than just tennis players – it commonly develops in people who perform repetitive arm and wrist movements. The condition involves inflammation and micro-tears in the tendons that control wrist extension, particularly where they attach to the lateral epicondyle (the bony prominence on the outer elbow).

Causes

Tennis elbow develops when the tendons connecting your forearm muscles to your elbow become overloaded. This overloading leads to tiny tears in the tendon tissue, causing pain and inflammation. The primary cause is repetitive stress on the extensor carpi radialis brevis (ECRB) tendon, which helps stabilise the wrist when the elbow is straight.

Common activities that can cause tennis elbow include repetitive wrist extension movements, forceful gripping combined with wrist movement, and poor technique during sports or work activities. The condition typically develops gradually over weeks or months rather than from a single injury.

Risk Factors

Age: Most common between 30-50 years old
Occupation: Jobs requiring repetitive arm motions (painters, plumbers, carpenters, cooks)
Sports participation: Tennis, badminton, squash, weightlifting
Poor ergonomics: Improper workstation setup or tool usage
Previous elbow injuries: Past trauma increases susceptibility
Muscle imbalances: Weak shoulder or forearm muscles
Smoking: Reduces blood flow and impairs tendon healing
Sudden activity increase: Dramatically increasing arm use without conditioning

Signs & Symptoms

Mild Symptoms

Mild discomfort on the outer elbow after activity
Slight tenderness when pressing the lateral epicondyle
Minor weakness in grip strength
Occasional pain with wrist extension
Stiffness in the elbow after periods of rest

Moderate Symptoms

Persistent pain during daily activities
Difficulty holding objects like cups or pens
Pain radiating down the forearm
Increased discomfort with twisting motions
Night pain affecting sleep quality
Visible swelling around the outer elbow

Severe Symptoms

Constant pain even at rest
Inability to fully extend the elbow
Severe weakness preventing normal activities
Pain spreading to upper arm or shoulder
Complete loss of grip strength
Burning or tingling sensations

Symptoms typically begin gradually and worsen over weeks to months. The dominant arm is more commonly affected, and pain usually intensifies with activities requiring gripping or wrist movement.

Experiencing these symptoms? Don’t wait for them to worsen.

Schedule a consultation with our Senior Consultant orthopaedic surgeon for accurate diagnosis and personalised treatment plan.

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When to See a Doctor

You should consult an orthopaedic surgeon if your elbow pain persists for more than two weeks despite rest and home remedies. Immediate medical attention is necessary if you experience severe pain limiting daily activities, inability to carry objects or use your arm, signs of infection such as fever or warmth around the elbow, or deformity or significant swelling of the elbow joint.

During your first consultation, our orthopaedic surgeon will conduct a comprehensive evaluation including detailed medical history, physical examination with specific diagnostic tests, and assessment of your work and recreational activities. The appointment typically takes 30-45 minutes, allowing for a thorough evaluation and discussion of treatment options. Early intervention often leads to faster recovery and prevents the condition from becoming chronic.

Diagnosis & Testing Methods

Accurate diagnosis of tennis elbow involves several assessment methods. The physical examination includes specific tests such as the Cozen’s test, where pain is reproduced by resisting wrist extension, and the Mills’ test, which involves passive wrist flexion with the elbow extended. Your doctor will also palpate the lateral epicondyle to identify the exact location of tenderness.

While tennis elbow is primarily diagnosed through clinical examination, imaging studies may be ordered to rule out other conditions or assess severity. X-rays can exclude arthritis or bone abnormalities. Ultrasound imaging visualises tendon thickness and tears in real-time. MRI scans provide detailed images of soft tissue damage when diagnosis is uncertain or treatment has been unsuccessful.

Additional diagnostic tools include electromyography (EMG) to rule out nerve compression and diagnostic injections to confirm the pain source. Results from physical examination are typically immediate, while imaging results may take 1-3 days, depending on the test performed.

Treatment Options Overview

Conservative Management

The foundation of tennis elbow treatment involves rest and activity modification. This includes avoiding repetitive movements that aggravate symptoms and using proper ergonomics during work and sports activities. Ice application for 15-20 minutes several times daily helps reduce inflammation during acute phases.

Physiotherapy

Specialised physiotherapy forms a crucial component of treatment. Therapists employ various techniques, including eccentric strengthening exercises, manual therapy to improve tissue mobility, and stretching programmes for forearm muscles. Treatment typically involves 2-3 sessions weekly for 6-12 weeks, with home exercise programmes to maintain progress between sessions.

Bracing and Support

Tennis elbow braces or counterforce straps reduce stress on the affected tendons. These devices work by dispersing forces away from the injured area during activities. Wrist splints may be recommended for night use to prevent prolonged positioning that stresses the tendons. Proper fitting and positioning are essential for effectiveness.

Oral Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) help manage pain and inflammation during acute phases. These medications are typically used for 2-3 weeks during flare-ups. Your doctor will consider your medical history and other medications when prescribing appropriate options.

Injection Therapies

Corticosteroid injections provide rapid pain relief for severe symptoms, though effects are often temporary. The injection targets the area of maximum tenderness around the lateral epicondyle. Platelet-rich plasma (PRP) injections use your own blood components to enhance healing. These treatments are considered when conservative measures provide insufficient relief after 6-12 weeks.

Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) uses acoustic waves to stimulate healing in chronic cases. Treatment involves 3-5 sessions spaced one week apart. This non-invasive option works by increasing blood flow and stimulating the body’s natural healing response. Patients typically experience gradual improvement over several weeks following treatment.

Surgical Options

Surgery is considered only when conservative treatments fail after 6-12 months. The procedure involves removing damaged tissue and reattaching the healthy tendon to the bone. Arthroscopic techniques allow minimally invasive surgery with smaller incisions and faster recovery. Open surgery may be necessary for more extensive damage. Post-surgical rehabilitation typically requires 4-6 months before returning to full activities.

Every patient’s condition is unique.

Our orthopaedic surgeon will assess your specific situation and recommend a suitable treatment approach for you.

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Complications if Left Untreated

Untreated tennis elbow can lead to chronic pain lasting years rather than months. The condition may progress to involve larger areas of tendon damage, making treatment more challenging. Persistent inflammation can result in tendon degeneration, where normal tendon tissue is replaced by weaker scar tissue.

Long-term complications include permanent weakness in grip strength and forearm muscles. Some patients develop compensatory problems in the shoulder or wrist from altered movement patterns. Chronic tennis elbow significantly impacts work productivity and may necessitate job modifications or career changes for those in manual occupations. The psychological impact of persistent pain can lead to reduced participation in sports and recreational activities, affecting overall quality of life.

Prevention

Preventing tennis elbow involves proper technique in sports and work activities. Learning correct form from qualified instructors reduces stress on the elbow tendons. Regular stretching and strengthening exercises for the forearm, particularly eccentric exercises, help maintain tendon health.

Workplace ergonomics plays a crucial role in prevention. This includes using tools with appropriate grip sizes, taking regular breaks during repetitive activities, and maintaining neutral wrist positions during work. Gradual progression when starting new activities allows tendons to adapt to increased demands. Using proper sports equipment, such as racquets with an appropriate grip size and string tension, reduces elbow stress. Regular equipment maintenance ensures optimal performance and injury prevention.

Tennis Elbow

Frequently Asked Questions

How long does tennis elbow typically take to heal?

Recovery time varies depending on severity and treatment approach. Most patients experience significant improvement within 6-12 weeks of conservative treatment including rest, physiotherapy, and activity modification. Complete healing may take 6-12 months. Chronic cases or those requiring surgery may need up to 18 months for full recovery. Adherence to treatment recommendations and avoiding aggravating activities significantly impacts healing time.

Can I continue playing sports with tennis elbow?

Activity modification rather than complete cessation is often recommended. You may need to temporarily reduce the intensity or frequency of sports participation. Working with our orthopaedic surgeon and physiotherapist, you can develop a gradual return-to-sport programme. This might include technique modifications, proper warm-up routines, and appropriate equipment adjustments. Some patients can continue modified activities while undergoing treatment, while others may need complete rest initially.

What’s the difference between tennis elbow and golfer’s elbow?

Tennis elbow affects the outer (lateral) side of the elbow, involving the tendons that extend the wrist. Golfer’s elbow affects the inner (medial) side, involving flexor tendons. Tennis elbow is more common and typically causes pain when lifting with the palm facing down. Golfer’s elbow causes pain with gripping or flexing the wrist. Both conditions can occur simultaneously, and treatment approaches are similar though targeting different anatomical structures.

Are steroid injections a permanent solution for tennis elbow?

Corticosteroid injections typically provide temporary relief lasting 6-12 weeks. While they effectively reduce inflammation and pain short-term, they don’t address underlying tendon damage. Multiple injections may weaken tendon tissue. Our orthopaedic surgeon uses injections judiciously as part of a comprehensive treatment plan, often to facilitate participation in physiotherapy. Long-term success requires addressing biomechanical factors and strengthening the affected tissues.

When is surgery necessary for tennis elbow?

Surgery is considered when conservative treatments fail to provide adequate relief after 6-12 months. Candidates for surgery typically have persistent pain significantly affecting daily activities, confirmed tendon damage on imaging studies, and have completed comprehensive conservative treatment. Our orthopaedic surgeon will discuss surgical options, expected outcomes, and recovery timeline during your consultation.

Can tennis elbow come back after successful treatment?

Recurrence is possible, particularly if causative factors aren’t addressed. Risk factors for recurrence include returning to activities too quickly, poor technique or ergonomics, and inadequate rehabilitation. Preventing recurrence involves continuing strengthening exercises, maintaining proper technique, and modifying activities that stress the elbow. Regular follow-up with your healthcare team helps identify and address issues before symptoms return.

Conclusion

Tennis elbow is a common but treatable condition that responds well to appropriate management. Understanding the causes, recognising symptoms early, and seeking timely treatment are key to successful recovery. Our comprehensive approach combines accurate diagnosis with evidence-based treatments tailored to your specific needs and goals. With proper treatment and rehabilitation, most patients return to their normal activities without limitations.

Take the First Step Towards Better Health

Living with tennis elbow can be challenging, but support is available. Seek help early allows early intervention based on diagnosis and using evidence-based approaches to help you manage your condition and return to daily activities.

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Dr Zackary Chua (蔡克祥医生)

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (AUS)|MMed (Singapore)|MRCS (Glasgow)|FRCSEd (Orth)

A senior consultant orthopaedic surgeon with dual specialisations in Foot & Ankle Surgery and Paediatric Orthopaedics. Backed by his extensive years of training and experience, Dr Chua brings the necessary knowledge and skills to ensure a smooth recovery journey.

Rooted firmly by two fundamental philosophies: “When one’s feet hurt, one hurts all over” and “Children are not little adults”, Dr Chua’s approach to patient care reflects his compassionate care for adults and children.

Singhealth Quality Excellence Award – Silver (2011)
Service From the Heart Award (2021)
Singapore Health Quality Service Award – Gold (2023)
NUS Medicine Dean’s Award for Teaching Excellence (2023)

His active participation in the medical community extends to mentoring, research supervision, and contributions to key professional forums and symposiums, both locally and internationally.