Elbow pain · MSK ultrasound · Treatment guide

Tennis Elbow: How It’s Diagnosed and the Treatment Pathway in London

What tennis elbow actually is, which symptoms matter, how ultrasound assesses the tendon and which treatments support recovery.

Written by Mr Pedram Aghaei, Medical Writer · MSc Medical UltrasoundClinically reviewed by Mr Paul Watson, Lead MSK Consultant ClinicianPublished and last reviewed: 9 September 2026
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Man holding the painful outside of his elbow alongside an ultrasound assessment

The name “tennis elbow” is a little misleading.

We see that because the symptom is basically a sore spot on the outside of the elbow, and it has more to do with the tendon in your elbow rather than holding a racquet.

It’s also pretty common in plumbers, gardeners and hairdressers—especially in people where gripping something, whether a tool or device, is a major part of their job and they do it repeatedly.

So here’s what’s really happening with that tendon, why it’s called tennis elbow, why an ultrasound is needed to diagnose it, and the treatment pathway for it in London.

What is tennis elbow?

Tennis elbow is a problem with the common extensor tendon where it meets the bone on the outside of the elbow. One of the muscles feeding into it, called extensor carpi radialis brevis, takes most of the load and usually takes most of the damage.

On the outside of your elbow, there’s a bony bump called the lateral epicondyle. The tendons that straighten your wrist and fingers all attach to this spot, sharing one thick anchor point called the common extensor tendon.

This happens when the tendon gets overused. Small tears build up faster than they can heal, and the tendon becomes painful and weak. It’s called tennis elbow because the backhand stroke in tennis can cause it, but most people get it from everyday activities like typing, using tools or lifting.

Why the name “tennis elbow” is misleading

You’ll often see it called lateral epicondylitis. The “-itis” ending suggests inflammation, but that’s not really what’s happening.

When these tendons are examined under a microscope, they show degeneration instead. The collagen fibres lose their orderly structure, the tendon thickens, and the natural repair process stalls.

And it’s not just tennis players who get it. Racquet sports account for only a small minority of cases.

The common thread is repetitive gripping, whether you’re holding a tennis racquet, a computer mouse, tools or anything else that strains those tendons over and over.

What are the symptoms of tennis elbow?

Common tennis elbow symptoms including outer elbow pain, forearm pain, weak grip and movement-related discomfort
Tennis elbow usually causes localised pain on the outside of the elbow and may reduce grip strength.

The symptoms of tennis elbow can usually range from:

Pain on the outside of the elbow

You can usually find the sore spot with one finger, right on or just below the bony bump. This is the most common symptom and matches clinical findings of tenderness at the extensor carpi radialis brevis origin.

Pain spreading down the forearm

It follows the muscles towards your wrist and stops before your hand. Some people feel pain travelling down the forearm, especially with twisting movements.

A weak and painful grip

Kettles, jars, door handles, a firm handshake. Many people notice the weakness before they notice the pain. Grip strength can drop by 20 to 40 per cent on the affected side.

Pain with specific movements

Bending your wrist back against resistance or straightening your fingers against something will typically reproduce the pain. This is a hallmark sign used in clinical diagnosis.

Morning stiffness

Stiffness in the morning that eases as you use the arm is common, particularly first thing after waking.

Pins and needles or numbness need attention. Pain with pins and needles in the hand, or numbness in the fingers, points somewhere else, usually a nerve. It’s best to mention it to the sonographer who assesses you.

Not sure whether it’s tennis elbow or something else?

A consultant orthopaedic assessment gives you a specialist’s opinion on what’s causing your pain and which treatment pathway makes sense for you.

Consultant Orthopaedic Assessment

Why does tennis elbow happen?

Tennis elbow usually happens because the tendon has been asked to do more gripping work than it can currently handle.

Every time you grip something, the muscles that straighten your wrist have to contract to keep the wrist stable. So gripping loads that tendon even when your wrist isn’t moving. This is why a job involving tools, secateurs, scissors or a mouse can produce it just as readily as sport.

How is tennis elbow diagnosed?

Diagnosis for tennis elbow usually starts with where the pain sits and what brings it on, followed by a few physical tests, such as:

Cozen’s test

You make a fist, turn your palm down, and push your wrist back against resistance. Pain over the outside of the elbow is a positive result.

Mill’s test

Your examiner straightens your elbow, turns your forearm inwards and bends your wrist down, stretching the tendon.

Maudsley’s test

You resist pressure on your middle finger as you try to straighten it, which loads the part of the tendon most often involved.

Grip strength

Grip is often measurably weaker on the affected side and painful at the same time.

Those tests are good at confirming that the outside of your elbow is the problem area. They will not tell you how far the tendon has degenerated, whether there’s a partial tear in it, whether calcium has built up, or whether the nearby ligament is involved.

They also can’t reliably separate tennis elbow from radial tunnel syndrome, where the radial nerve gets compressed a few centimetres further down the forearm and produces pain in almost the same place.

Elbow pain lasting more than six weeks is worth assessing properly

An elbow ultrasound assesses the common extensor tendon, common flexor tendon, collateral ligaments, bursae and the ulnar, radial and median nerves. Your findings are explained on the screen at the appointment and a written report follows. No GP referral is needed, and we’re open seven days a week at our Harley Street and St Albans clinics.

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What does an elbow ultrasound show?

Clinician performing an elbow ultrasound with enlarged tendon and anatomy views
Ultrasound provides a live assessment of tendon structure, nearby ligaments and relevant nerves.

During an elbow ultrasound, a probe goes over the outside of the elbow and puts a live picture of the tendon on the screen next to you. The scan takes about 20 to 30 minutes.

A healthy tendon has a tidy, organised fibre pattern. A tendon with tennis elbow looks different in several specific ways:

Thickening

A normal common extensor tendon measures roughly 4.4 to 5.3 mm, so measurable thickening is a clear finding.

Darker patches

These appear where the organised fibre structure has broken down.

New blood vessels

These show as colour on Doppler where the tendon is actively irritated.

Calcification

This appears as bright deposits within the tendon.

Partial tears

These are areas where fibres have pulled away from the bone.

The scan also covers the radial collateral ligament alongside the tendon, which matters if an injection is being considered, and the posterior interosseous nerve can be traced for signs of radial tunnel entrapment.

Where a nerve is suspected, a peripheral nerve ultrasound can visualise the nerve directly, showing whether it’s swollen, compressed or irritated at the point of entrapment.

What actually heals tennis elbow?

There are different treatment pathways when it comes to tennis elbow, and these are the most common ones we offer at London Private Ultrasound:

First-line treatment

Loading the tendon

This is the treatment with the strongest long-term evidence. Progressive strengthening of the wrist extensors rebuilds the tendon’s capacity, usually starting with isometric holds and moving on to slow, controlled work.

The eccentric wrist extension and the Tyler Twist, done with a flexible rubber bar, are the two exercises most often prescribed.

Both need doing consistently for months, which is the part most people underestimate. That’s why our personalised rehabilitation programme is built around what your scan finds and personalised for your journey to recovery.

Rehabilitation Programme
Short-term pain control

Corticosteroid injection

An ultrasound-guided corticosteroid injection brings pain down fast. The procedure uses live imaging, which means the medication reaches the intended spot rather than the ligament beside it.

But we see steroid injections as a short-term tool to calm a very painful elbow so you can start your loading programme. The loading is what does the long-term work.

Corticosteroid Injection
Persistent symptoms

Shockwave therapy

Shockwave is used for tendon problems that haven’t settled with a proper loading programme. It’s worth discussing once you’ve given loading a fair run, typically after three months of regular exercise.

We offer shockwave therapy in-house for stubborn tennis elbow that hasn’t responded to exercise alone. It uses high-energy sound waves to stimulate healing in the tendon and can be a useful next step when loading plateaus.

Shockwave Therapy
Regenerative pathway

Platelet-rich plasma

Platelet-rich plasma takes a small sample of your own blood, concentrates the platelets and injects them into the tendon under ultrasound guidance. It’s used for stubborn tendinopathy that hasn’t responded to loading, and unlike a steroid, it isn’t working by suppressing anything.

Research shows PRP provides significantly better pain relief and functional improvement at six months and beyond compared with corticosteroids. Multiple trials show benefit for tennis elbow specifically.

PRP Therapy
Last resort

Surgery

Surgery is generally considered only after 6 to 12 months of proper non-surgical treatment, in line with NHS guidance. Very few people with tennis elbow get there.

How long does tennis elbow take to get better?

The NHS puts it plainly: tennis elbow usually gets better after resting your arm for a few weeks, but it can sometimes last longer.

In practice, most people are looking at months rather than weeks. Mild cases caught early often feel substantially better within 6 to 12 weeks of consistent loading work. Moderate cases commonly take 3 to 6 months. Long-standing ones can take up to a year.

Two things tend to stretch it out. The first is continuing the gripping activity that caused it while hoping it settles. The second is a stop-start rehabilitation programme, where every flare-up leads to a fortnight of rest and the tendon never builds any capacity.

Why book your elbow ultrasound with London Private Ultrasound?

Lateral elbow pain gets treated on assumption more often than almost anything else we scan.

An elbow ultrasound answers that in half an hour, and here’s why it’s worth booking one with us:

The tendon is measured

Thickening, degeneration, calcification and partial tears all get documented, so there’s a baseline to compare against later.

The ligament and nerve are checked

The radial collateral ligament sits right beside the tendon and matters for injection safety, and the radial nerve is traced where radial tunnel syndrome is a possibility.

Expert sonographers

Every scan is read by the clinician who performed it, from a team combining orthopaedic surgery, MSK ultrasound and radiology.

Treatment at our orthopaedic clinic

Loading programmes, guided injections, shockwave and PRP are all handled by the Joint Pain Clinic at London Private Ultrasound.

Same-day appointments

Same-day and next-day slots, seven days a week, 9am to 7pm, with no GP referral needed. We’re at 27 Welbeck Street in the Harley Street medical district and 54–56 Victoria Street in St Albans.

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Related services

Elbow ultrasound

Assessment of the common extensor and flexor tendons, collateral ligaments, bursae and relevant nerves, with your findings explained at the appointment.

Elbow Ultrasound

Consultant orthopaedic assessment

A specialist opinion on the cause of your elbow pain and which treatment pathway is most appropriate.

Orthopaedic Assessment

Joint Pain Clinic

Ultrasound-guided injections, shockwave therapy, PRP and personalised rehabilitation pathways for persistent joint and tendon pain.

Joint Pain Clinic

Peripheral nerve ultrasound

Direct imaging of a nerve where swelling, compression or irritation is suspected around the elbow or forearm.

Peripheral Nerve Ultrasound

Frequently asked questions

What actually heals a tennis elbow?

Progressive loading of the wrist extensor tendons, done consistently over months, alongside changes to the gripping activity that caused it. In the JAMA trial, 93% of people who had a placebo injection and no steroid had recovered or much improved at a year.

How is tennis elbow treated in the UK?

The usual sequence is self-care and activity changes first, physiotherapy if there’s no improvement after around six weeks, then injections or shockwave for stubborn cases, with surgery considered only after 6 to 12 months of proper non-surgical treatment.

What is the most effective treatment for tennis elbow?

Loading, based on the long-term evidence. Injections work faster, and the JAMA trial found worse outcomes at one year and a 55% recurrence rate compared with 12% after placebo, so they’re best used to make loading possible rather than instead of it.

What is the best doctor to see for tennis elbow?

Most people start with a GP or a physiotherapist experienced in tendon loading. If there’s been no improvement after a proper loading programme, or the diagnosis is unclear, a consultant orthopaedic assessment alongside imaging is the next step.

What is the best tennis elbow support in the UK?

A counterforce strap worn a few centimetres below the elbow is the usual choice for gripping tasks, and an elbow sleeve suits people who want general support and warmth. Both help you get through the day, and neither treats the tendon, so use one alongside a loading programme.

How much does tennis elbow surgery cost in the UK?

Private costs vary considerably between hospitals and surgeons, and quotes often separate the hospital fee from the surgeon’s and anaesthetist’s fees, so ask for a full inclusive quotation. Very few people with tennis elbow need surgery, and it’s normally considered only after 6 to 12 months of non-surgical treatment.

Is tennis elbow the same as golfer’s elbow?

They’re the same kind of problem on opposite sides. Tennis elbow affects the tendon on the outside of the elbow; golfer’s elbow affects the tendon on the inside. An elbow ultrasound covers both, since it assesses the common extensor and common flexor tendons.

Do I need a GP referral for an elbow ultrasound?

No. You can book directly. If you’d like your results sent on to your GP, physiotherapist or consultant, just tell us on the day.

Medical disclaimer: This article provides general patient information and does not replace a medical consultation, examination or personalised advice. Seek urgent assessment after significant trauma, for a hot and markedly swollen joint, rapidly increasing weakness, or new persistent numbness.
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Been months with no improvement?

It’s best to get an expert opinion. Book an elbow ultrasound scan with London Private Ultrasound and get same-day results, a GP appointment if needed, with clinics in Harley Street and St Albans, open seven days a week.

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