Tennis Elbow

Tennis elbow, medically known as lateral epicondylitis, is a condition characterised by pain and tenderness on the outside of the elbow. Despite its name, tennis elbow is not limited to tennis players; it can affect anyone who engages in repetitive arm, elbow, and wrist activities. This condition can cause significant discomfort and impair the ability to perform everyday tasks.

Experiencing pain, swelling or stiffness in the elbow? Consult our tennis elbow specialist for an accurate diagnosis & personalised treatment plan today.

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Dr Dennis Ng Zhaowen
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Causes of Tennis Elbow

Tennis elbow is primarily caused by repetitive stress and overuse of the forearm muscles and tendons that attach to the lateral epicondyle, the bony prominence on the outside of the elbow. Several factors contribute to the development of this condition:

  • Repetitive Motions: Engaging in repetitive motions that involve the forearm, wrist, and elbow can strain the tendons and muscles, leading to inflammation and microtears. Common activities include tennis, racquet sports, and repetitive manual labour.
  • Poor Technique: Using improper technique in sports or activities that involve repetitive arm movements can increase the stress on the tendons. For instance, incorrect grip size or poor backhand technique in tennis can contribute to the development of tennis elbow.
  • Occupational Hazards: Jobs that involve repetitive arm and wrist movements, such as carpentry, painting, and plumbing, can lead to tennis elbow. The repetitive nature of these tasks places continuous strain on the tendons.
  • Activities Without Proper Conditioning: Engaging in activities without proper conditioning or warm-up can place sudden, excessive stress on the forearm muscles and tendons, increasing the risk of injury.

Symptoms of Tennis Elbow

Tennis elbow manifests with several symptoms, primarily affecting the outer part of the elbow and forearm. Recognising these symptoms early can aid in timely diagnosis and treatment. Common symptoms include:

  • Stiffness
    Stiffness in the elbow joint, particularly in the morning or after periods of inactivity, is a common symptom. This stiffness can limit the range of motion.
  • Pain with Specific Movements
    Pain typically worsens with specific movements, such as lifting, gripping, or twisting the forearm. Activities like turning a doorknob, shaking hands, or holding a cup can be particularly painful.
  • Pain, Tenderness and Swelling
    Pain and tenderness are typically felt on the outside of the elbow at the lateral epicondyle. The pain may extend down the forearm and can worsen with activities involving the wrist and arm. In some cases, mild swelling around the elbow may occur due to inflammation of the tendons.

Diagnosis of Tennis Elbow

Diagnosing tennis elbow involves a combination of a thorough medical history, physical examination, and, in some cases, imaging studies. The following steps are typically taken to confirm the diagnosis:

Medical History

The doctor will begin by taking a detailed medical history, asking about the onset of symptoms, activities that exacerbate the pain, occupation, and any previous injuries to the elbow or forearm.

Physical Examination

During the physical examination, the doctor will palpate the lateral epicondyle to check for tenderness and swelling. They will also assess the range of motion and strength of the forearm and wrist. Specific tests, such as the Cozen’s test and Mill’s test, may be performed to evaluate pain and function.

Imaging Studies

Imaging studies can help rule out other conditions and confirm the diagnosis of tennis elbow. Common imaging techniques include:

  • MRI: Magnetic resonance imaging (MRI) provides detailed images of the soft tissues, including tendons and muscles. MRI can help identify the extent of tendon damage and any other associated abnormalities.
  • Ultrasound: Ultrasound imaging uses sound waves to create images of the soft tissues around the elbow. It can be useful for detecting inflammation and tears in the tendons.

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Treatment Options for Tennis Elbow

Treatment for tennis elbow focuses on relieving pain, reducing inflammation, and promoting healing of the affected tendons. The treatment approach can be conservative or, in persistent cases, surgical.

Non-Surgical Treatments

Non-surgical treatments are generally the first option for treating tennis elbow.

  • Rest and Activity Modification: Resting the affected arm and avoiding activities that exacerbate the pain are crucial initial steps. Modifying activities to reduce strain on the elbow can prevent further injury.
  • Ice Therapy: Applying ice packs to the elbow for 15-20 minutes several times a day can help reduce inflammation and alleviate pain. Ice should be wrapped in a cloth to avoid direct contact with the skin.
  • Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help manage pain and reduce inflammation. These medications should be used as directed by a healthcare professional.
  • Bracing: Wearing a brace or strap over the forearm can help reduce strain on the affected tendons by redistributing the load. These supportive devices can alleviate pain and prevent further injury by stabilising the area and limiting excessive movement.
  • Corticosteroid Injections: In some cases, corticosteroid injections may be administered to reduce severe inflammation and pain. These injections can provide rapid relief by decreasing inflammation around the affected tendon. Corticosteroid injections are considered when other conservative treatments, such as anti-inflammatory medications, have not provided sufficient relief.
  • Platelet-Rich Plasma (PRP) Therapy: PRP therapy involves injecting a concentration of the patient’s own platelets into the affected tendon to promote healing. The process begins with drawing a small amount of the patient’s blood, which is then processed to separate the platelets. These concentrated platelets are rich in growth factors and are injected directly into the injured tendon. PRP therapy aims to accelerate the body’s natural healing process, reduce pain, and improve tendon function.
Surgical Treatments

Surgery is considered when conservative treatments fail to provide relief or if there is significant tendon damage. Surgical options include:

Tendon Release

This procedure involves removing the damaged portion of the tendon and reattaching the healthy part to the bone. Tendon release is often used to alleviate pain and improve function by addressing the compromised section of the tendon. Performed under local or general anaesthesia, a small incision is made to access the affected tendon. The doctor removes the damaged section and reattaches the remaining healthy tendon to the bone.

Tendon Repair

In cases of severe tendon damage, the doctor may repair the tendon by stitching the torn ends together or using a graft to reinforce the tendon. This method is designed to restore the tendon’s integrity and function. Usually done under general anaesthesia, an incision is made to expose the damaged tendon. Repair techniques include direct repair, where the torn ends of the tendon are stitched together, or grafting, where a tendon graft (often from another part of the body) is used to reinforce the repair.

Radiofrequency Microtenotomy

This is a minimally invasive surgical procedure for recalcitrant lateral epicondylitis of the elbow. It involves targeted coblation of pathological tissue at significantly lower temperatures. The procedure consists of using a cauterizing needle to remove the inflammation and stimulate the tendon to heal.

Prevention of Tennis Elbow

Preventing tennis elbow involves adopting strategies that minimise the risk of overuse and strain on the forearm muscles and tendons. Here are some effective prevention tips:

  • Proper Technique - It is important to use correct techniques in sports and activities that involve repetitive arm movements. For example, in tennis, ensure that the grip size of the racquet is appropriate and that the backhand stroke is executed correctly.
  • Regular Stretching and Strengthening - Incorporate regular stretching and strengthening exercises for the forearm muscles to maintain flexibility and build strength. Exercises such as wrist curls, reverse wrist curls, and finger extensions can be beneficial.
  • Gradual Increase in Activity - When starting a new exercise regimen or increasing the intensity of physical activities, it is important to do so gradually. Sudden increases in activity levels can overload the tendons.
  • Warm-Up and Cool-Down - Always perform a thorough warm-up before engaging in physical activities and a cool-down afterwards. This helps prepare the muscles and tendons for activity and reduces the risk of injury.
  • Take Breaks - Taking regular breaks during repetitive tasks can help prevent overuse injuries. This is particularly important for occupations that involve repetitive arm and wrist movements.
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Our Patients' Feedback

Learn what our patients have to say about our treatments and services.

Jeremy Teo
Jeremy Teo
2024-05-16
I tore my left pec muscle after a bench press accident and had the fortune of getting help from Dr Dennis. He is a very caring and helpful individual that you can tell wants the best healing progress for you and actively follows up with you sincerely. I initially had a two month delay and misdiagnosis at Ktph and it caused my tendon to retract. Should have went to Dr Dennis from the start.. 5/5
Emily Loo
Emily Loo
2024-05-16
I felt that doctor Dennis is very experienced and he skilfully aligned my fractured toe after my accident so that I didn’t need to do a minor surgery. He was friendly and professional and I felt his fees were reasonable without additional overselling of tests, supplements etc. that I have experienced elsewhere. Overall it was a smooth and effective experience and I would highly recommend doctor Dennis.
Ming W
Ming W
2024-04-20
Wonderful experience with Dr. Dennis and his team. The staff were attentive and efficient. Dr. Dennis is professional, caring and knowledgeable. I had a shoulder injury and knee injury that required surgery. The whole journey, including pre and post surgery, Dr. Dennis and his team made sure I received the best treatment possible. Really thankful for the team and I definitely will recommend this place to others.
Jermy Tan
Jermy Tan
2024-04-02
Saw Dr Dennis for my lumbar slipped disc. Great doctor and he explained clearly the different options available. Went with surgery and have been recovering well since then.
Amanda Seah
Amanda Seah
2024-03-02
I came in with a shoulder injury that meds from a GP did not relieve one month ago. Dr Dennis and his team were great in diagnosing the exact injury with an mri, and he prescribed physio. My shoulder condition has greatly improved and I can now move my arm almost completely! Thank you Dr Dennis!
Jaslyn HENG (Kenrick)
Jaslyn HENG (Kenrick)
2024-02-19
A very friendly and nice doctor who manage to cure my elbow issue whjch has been bothering me for more than 6 months! Thank you Doctor Dennis!
Xianmin Jiang
Xianmin Jiang
2024-02-07
I had severe left shoulder pain due to exercise. After MRI checking , it was shown high-grade tendon tearing. Dr Dennis did the surgery for my left should calf repair. After surgery, I strictly follow what he suggested. The recovery was really amazing and fast. I was curious about what happened to my shoulder, he explained in details and with great patience. Now, I am fully recovered in a very fast speed and come back to my loved sports and exercises. I definitely recommend Dr Dennis for his profession, patience and delicate skills. Last not the least, thank for his medical team. The nurses are always prompt to reply when I need help and message them.
Omar Lechuga
Omar Lechuga
2023-12-27
Dr. Dennis helped me with an elbow pinch coming from a trauma. His attention to detail confidence and great empathy really helped me to fully recover. Thank you Dr. Dennis.
Benjamin Mah
Benjamin Mah
2023-12-09
Dr Dennis has been helpful in the diagnosis and explanation of my injury

Dr Dennis Ng Zhaowen
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #08-41,Singapore 329563

Dr Dennis Ng Zhaowen

  • Senior Consultant Orthopaedic Specialist
MBBS (Singapore)
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MRCSEd
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MMED
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FRCSEdOrth (Gold Medal Award)

Before private practice, Dr Dennis Ng was the former Deputy Head of the Shoulder & Elbow Division and Sports Knee Division in National University Hospital.

He completed his fellowship at the prestigious Fowler Kennedy Sports Medicine Centre in London, Ontario, Canada, and has rich experience treating professional athletes and returning them to sports. 

Special areas of interests include keyhole and reconstructive procedures of the elbow. 

Common procedures include Elbow ligament repair / reconstruction, Tennis elbow release, Radiofrequency microtenotomy, Fracture fixation etc.

 

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    Visit Us Today

    Mount Elizabeth Novena Specialist Centre

    38 Irrawaddy Road #08-41
    Singapore 329563

    Monday – Friday: 9am – 1pm; 2pm – 5pm
    Saturday: 9am – 1pm
    Sunday & PH: CLOSED

    Other Clinic Location

    Gleneagles Medical Center

    6 Napier Road #07-15
    Singapore 258499

    Monday – Friday: 9am – 1pm; 2pm – 5pm
    Saturday: 9am – 1pm
    Sunday & PH: CLOSED

    Frequently Asked Questions (FAQs)

    When should I seek medical attention for tennis elbow?

    Seek medical attention if you experience persistent pain, increasing pain and weakness, pain with minimal activity, difficulty with grip, significant swelling and stiffness, limited range of motion, no improvement with conservative treatments, or recurring symptoms.

    Can tennis elbow lead to complications?

    Yes, if left untreated, tennis elbow can lead to chronic pain, reduced function, and impaired ability to perform daily tasks.

    How long does it take to recover from tennis elbow?

    Recovery time varies depending on the severity of the condition and the effectiveness of treatment. Mild cases may improve within a few weeks with conservative treatment, while more severe cases may take several months. Consistent adherence to treatment and rehabilitation exercises is crucial for recovery.

    Is surgery always required for tennis elbow?

    No, surgery is not always required for tennis elbow. Most cases can be effectively managed with conservative treatments such as rest, physical therapy, medications, and injections. Surgery is typically considered only when these treatments fail to provide relief or if there is significant tendon damage.

    +65 9751 1486