Simple self-help treatments and a few days’ rest are often enough to clear up a spell of elbow pain. However, if you do have a more complex or persistent problem, your doctor will be able to recommend other treatments and therapies that should help.
Physiotherapy may be useful to help you build up the strength in your elbow and prevent the condition returning.
Your physiotherapist will help you to keep up or regain the flexibility in your elbow through exercise. You should stretch out your elbow at least once a day and do general range-of-movement exercises to prevent contractures, and try biceps and triceps strengthening exercises with light weights or resistance bands as recommended by your physiotherapist.
Acupuncture is used widely in physiotherapy and may be used in elbow conditions. Although there’s no strong evidence of its benefit for elbow pain some people do seem to find it helpful. Physiotherapists can also fit epicondylitis clasps (see What can I do to help myself?). Clasps are particularly useful for tennis and golfer’s elbow but not cubital or radial tunnel syndrome.
Physiotherapists can strap or tape the joint or soft-tissue to reduce strain.
If you’re in severe pain or you don’t seem to be recovering within a few weeks, see your doctor. They may suggest you have a steroid injection. The pain can become worse for a few hours afterwards, and occasionally it may be severe and last up to 48 hours, but most people recover after this. You may need a second injection if the pain continues.
Steroid injections are an effective treatment with very few side-effects, although if you’ve had tennis elbow for more than 6 weeks there’s no evidence that they work. Most people will get better over time whether they have an injection or not – sometimes an injection just speeds the recovery.
If you have an inflammatory arthritis of the elbow, like that seen in rheumatoid arthritis, your specialist may inject the joint as part of your treatment.
Platelet-rich plasma injections
A new technique called platelet-rich plasma (PRP) is becoming an increasingly popular treatment for tennis elbow.
It involves taking a blood sample from the patient, which is then treated to increase the number of platelets compared with other cells in the sample. This is then reinjected into the painful area, stimulating healing in the nearby tissues. Recent international studies have shown that PRP may reduce pain and increase function more effectively than steroid injections.
Most cases of elbow pain will heal using the treatments above, but a small number of people will need surgery to ease their symptoms. There are different surgeries for the conditions. Most operations are carried out as day-case procedures and you’ll be able to go home the same day.
After the operation you’ll need to follow a regular stretching programme at home as well as having physiotherapy. Ask your doctor to show you which stretches will be useful.
You’ll probably need to go back to the hospital for a check-up after two weeks. You should usually only need two weeks off work unless your job involves heavy manual work, when you may need four to six weeks off.
If your stiffness is caused by abnormal bone formation or soft tissue contractures, you may need an operation to remove the abnormal bone or release the contracted tissues.
After the operation, your elbow will probably be moved with the help of a machine for a few days and you’ll need intensive physiotherapy as an outpatient afterwards.
The operations probably won’t restore your full range of movement, and the blood vessels and nerves around the shoulder can be damaged during the operation, but this isn’t common.
Sometimes abnormal bone can form in the muscles around the elbow, causing more stiffness.
If loose pieces of bone are causing pain, they can be removed arthroscopically. This means the operation can be done through just a small cut (incision), so your joint doesn’t have to be opened up. This type of operation is also known as keyhole surgery. Abnormal bone can be removed from the joint in an open surgical procedure (through a bigger incision).
If elbow arthritis is making it difficult for you to carry on with your daily life or is causing a lot of pain and restricting your movement, an elbow replacement may be useful.
Your consultant rheumatologist or orthopaedic surgeon will tell you if this is necessary.
Read more about elbow replacement surgery.
Tennis elbow and golfer’s elbow
Surgery is only needed for a small number of people with these conditions.
The operation for tennis elbow involves removing part of the affected tendon. For golfer’s elbow the procedure involves clearing damaged tissue from the affected muscle.
These operations can be done using keyhole surgery or through a cut about 4–5 cm long. You should be able to start using the elbow straight after these operations and you’ll usually need a short course of physiotherapy.
A small number of cases may need surgery if this condition keeps coming back or affects everyday activities. The operation involves removing the bursa through a cut at the back of the elbow. Some surgeons have recently started to use keyhole surgery for this procedure.
Cubital and radial tunnel syndromes
A small number of people will need surgery for these conditions. The operation involves making a cut to find the affected nerve, which is then freed from the tissues that are pressing on it.
You can use your elbow for activities that don’t involve heavy lifting straightaway and continue with other tasks as your pain allows.
Distal biceps rupture
Surgery may be recommended depending on your level of activity and whether or not your activities need you to twist your forearm. This operation involves making a cut over the front of the elbow and fixing the torn tendon onto the radius.
Most surgical wounds normally heal within two weeks, but if you’ve had an operation that involves the back of your elbow it may take longer because the skin here has a fairly low blood supply. The wound may also ‘weep’, although neither of these are very common.