Tennis Elbow Treatment London | Private Ultrasound Diagnosis & Injections

Tennis Elbow (Common Extensor Tendon Pain) Explained

Forearm Extensor Muscle & Tendon Anatomy

Tennis elbow is the common name used for tendon pain over the outer elbow. The tendon affected in tennis elbow is the common extensor tendon, which refers to the structure that attaches the outer forearm muscles (that extend the wrist and fingers) to a bony prominence called the lateral epicondyle, located just above the elbow.

Typical Tennis Elbow Symptoms

The tendon affected in tennis elbow is commonly painful during activities that place load through the forearm muscles and tendon. Aggravating activities often involve gripping and twisting motions with the hand and fingers, typing, and lifting heavier items with the palm down.

The name "Tennis Elbow" comes from the fact that similar loading patterns occur in backhand strokes in racket sports, which can also contribute to the development of this condition.

The Causes of Tennis Elbow

Tennis elbow can occur for a variety of reasons. It is often caused by writing or typing with poor ergonomics, increased heavy lifting without appropriate progression, or, occasionally, by a direct blow to the outer elbow — for example, hitting it against a door or wall — which can cause swelling at the tendon-to-bone interface.

Diagnosing Tennis Elbow

Due to the very superficial attachment point of the tendon, ultrasound scan is the gold standard form of imaging for assessing any bony irregularity at the bone-tendon attachment, or any intrasubstance tears of the common extensor tendon itself.

Underlying the tendon is the radial collateral ligament of the elbow, which can also give rise to similar symptoms. In addition, the radial head and radiohumeral joint can be assessed with ultrasound to exclude significant bony irregularity or swelling, which may represent an alternative cause of lateral elbow pain.

Tennis Elbow Ultrasound Guided Injections

How is a Tennis Elbow Injection Administered?

Physical therapy exercises are typically considered the first line of treatment for tennis elbow. However, in acute cases where individuals are unable to work or participate in leisure activities — or where physical therapy has not been effective — a corticosteroid or prolotherapy-type injection to the tendon may be considered.

An ultrasound-guided injection can be performed by placing the probe longitudinally over the common extensor tendon, with the proximal attachment of the tendon onto the lateral epicondyle at one end of the screen, and the distal aspect of the tendon and myotendinous junction at the other end.

A needle can be inserted and visualised from the distal end of the probe, progressing through either the superficial fibres, deeper fibres, or toward the bone-tendon interface, as indicated by the exact structural diagnosis.

What to Do After Your Tennis Elbow Injection

Needle Path & Post-Injection Pain
Depending on your ultrasound findings, the injection may be placed either superficially to “bathe” the tendon or directed into the tendon fibres to deliberately disrupt them and stimulate healing. Because of this, some post-injection soreness for several days is common.

In addition, although uncommon, some people may experience a post-injection flare caused by the steroid crystals in the medication reacting with surrounding synovial fluid.

Try to avoid non-steroidal anti-inflammatory medication in cases of persistent Tennis Elbow as there is evidence these medications reduce the ability for the tendon to regenerate.

Wound Care & Infection Risk
As with all ultrasound-guided injections, avoid exposing the injection site to dirty or public water (e.g., swimming pools, hot tubs) for 2–3 days to reduce infection risk. Monitor for any redness, swelling, or discharge at the injection site and contact me if these occur.

Activity Guidance
Loading exercises and activities involving gripping or twisting with the wrist and hand should be stopped for two weeks after the injection. After two weeks, a graded exercise program can be started to progressively strengthen and rehabilitate the elbow.

Follow-Up
If you experience significant pain, swelling, redness, or other unexpected symptoms following your injection, please contact me immediately.

Other Treatments for Tennis Elbow

Physical Therapy Flexibility Exercises for Tennis Elbow

Common Extensor Tendon "Tennis Elbow" Strengthening Exercises

Ergonomic Changes for Improving Tennis Elbow

AC Joint Pain | Evidence base

The natural course of tennis elbow is favorable, with most cases resolving within 6 to 24 months. High-quality studies support physiotherapy involving progressive tendon loading, ergonomics, and activity modification as effective for improving pain and function. Corticosteroid injections can reduce symptoms more rapidly in the short term, but carry a higher risk of symptom recurrence and poorer long-term outcomes compared to exercise-based rehab. Repeated injections are not advised due to these risks. PRP and other regenerative therapies have mixed evidence, and surgery is rarely needed, typically reserved for chronic cases unresponsive to a full course of conservative management.

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