Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Practising at Mount Elizabeth Novena Hospital, Singapore
Appointments by prior arrangement
Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Mount Elizabeth Novena Hospital, Singapore
✔ Subspecialty Focus in Shoulder & Elbow, Sports Injuries
✔ Practising at Mount Elizabeth Novena Hospital
✔ Evidence-based treatment, Individualised Care
Tennis Elbow Treatment in Singapore
Tennis elbow, also known as lateral epicondylitis or lateral elbow tendinopathy, is a common cause of pain on the outer side of the elbow. Pain is often aggravated by gripping, lifting, racquet sports, gym exercises or repetitive use of the hand and wrist.
Despite its name, tennis elbow does not only affect tennis players.
Most patients improve without surgery. Treatment usually focuses on identifying aggravating loads, appropriate rehabilitation and progressively restoring the strength and capacity of the affected tendon. Injections or surgery may be considered in selected patients with persistent symptoms.
Dr Puah Ken Lee is a fellowship-trained orthopaedic surgeon with a subspecialty focus in shoulder and elbow surgery and sports injuries. He assesses and treats patients with tennis elbow and other causes of lateral elbow pain at 360 Orthopaedics, Mount Elizabeth Novena, Singapore.
What Is Tennis Elbow?
Tennis elbow affects the common extensor tendon where the muscles responsible for extending the wrist and fingers attach to the outer side of the elbow.
The extensor carpi radialis brevis (ECRB) tendon is commonly involved.
Although the traditional term is lateral epicondylitis, persistent tennis elbow is not simply an inflammatory condition. Repeated loading can result in changes within the tendon and an impaired healing response, which is why the condition is also described as lateral elbow tendinopathy.
What Causes Tennis Elbow?
Tennis elbow commonly develops when the tendon is repeatedly exposed to loads that exceed its current capacity.
Activities associated with symptoms may include:
- Tennis and other racquet sports
- Golf
- Weight training
- Repetitive gripping
- Lifting objects with the arm extended
- Manual work involving tools
- Repetitive wrist and forearm movements
- A sudden increase in training or activity
There is not always a single identifiable injury.
What Are the Symptoms of Tennis Elbow?
Typical symptoms include:
- Pain over the outer side of the elbow
- Pain during gripping
- Pain when lifting objects
- Pain with resisted wrist extension
- Reduced grip strength because of pain
- Difficulty with racquet sports or gym exercises
- Pain during repetitive work involving the hand and wrist
Symptoms can range from relatively mild discomfort during activity to persistent pain that interferes with work, exercise and everyday activities.
Is It Really Tennis Elbow?
Not every case of pain on the outer side of the elbow is tennis elbow.
Other conditions can produce similar symptoms, including:
- Radial tunnel or posterior interosseous nerve-related pain
- Radiocapitellar joint pathology
- Elbow arthritis
- Synovial plica
- Cartilage injury
- Lateral ligament injury or elbow instability
- Pain referred from the neck
- Other tendon disorders
The location of tenderness, movements that reproduce symptoms, elbow stability, range of motion, strength and neurological examination can help distinguish these conditions.
This distinction becomes particularly important when presumed tennis elbow has not improved as expected.
Persistent lateral elbow pain should prompt reassessment of the diagnosis rather than simply repeating the same treatment indefinitely.
How Is Tennis Elbow Diagnosed?
Tennis elbow is primarily a clinical diagnosis.
Assessment usually includes a history of the symptoms and examination of:
- The site of tenderness
- Pain with gripping
- Pain with resisted wrist or finger extension
- Elbow range of motion
- Elbow stability
- Forearm and grip strength
- Neurological findings where relevant
Imaging is not always necessary for straightforward cases.
Do I Need an Ultrasound or MRI for Tennis Elbow?
Not every patient with tennis elbow requires a scan.
Ultrasound
Ultrasound can assess the common extensor tendon and may demonstrate changes such as tendinopathy or tendon tearing.
It also allows the tendon and surrounding structures to be examined dynamically.
X-rays
X-rays may be appropriate when there is concern about arthritis, previous injury or another bony or joint-related cause of elbow pain.
MRI
MRI may be useful when symptoms are persistent or atypical, when another diagnosis is suspected, or when surgery is being considered.
Imaging findings should always be interpreted together with the patient’s symptoms and clinical examination.
A scan showing tendon changes does not by itself determine whether an injection or surgery is required.
How Is Tennis Elbow Treated?
Most patients with tennis elbow do not require surgery.
Treatment should address both the symptoms and the loads being placed on the tendon.
Activity and Load Modification
Complete rest is not usually the objective.
Instead, it may be helpful to identify the activities that repeatedly aggravate the tendon and temporarily modify their frequency, intensity or technique.
This might involve adjusting:
- Racquet-sport training
- Weight-training exercises
- Repetitive gripping
- Lifting technique
- Manual work
- Other activities involving repeated wrist extension
As symptoms improve and tendon capacity increases, activity can progressively be restored.
Physiotherapy and Progressive Strengthening
Rehabilitation is an important part of treatment.
A programme may include:
- Progressive wrist-extensor strengthening
- Isometric, concentric or eccentric exercises where appropriate
- Grip-strengthening exercises
- Forearm conditioning
- Assessment of shoulder and upper-limb mechanics
- Sport-specific rehabilitation
- Gradual reintroduction of provocative loads
The objective is not simply to make the elbow temporarily less painful, but to improve the tendon’s ability to tolerate the demands of work, exercise or sport.
Bracing
A counterforce strap or wrist brace may reduce symptoms during selected activities in some patients.
Bracing is generally used as a symptom-management tool rather than as a treatment that directly restores the tendon.
Medication
Pain-relieving medication may be useful for short-term symptom control when appropriate.
Persistent tennis elbow, however, is not simply an inflammatory disorder. Medication therefore does not replace appropriate load management and rehabilitation.
Do Injections Help Tennis Elbow?
Injections are sometimes considered for persistent tennis elbow, but different injections have different aims and evidence.
An injection should not automatically replace rehabilitation or correction of the activity that is repeatedly overloading the tendon.
Corticosteroid Injection
Corticosteroid injection can provide short-term pain relief in some patients.
However, studies have raised concerns about recurrence and longer-term outcomes following corticosteroid injection for tennis elbow. For this reason, repeated corticosteroid injections are not necessarily an appropriate strategy for persistent lateral elbow tendinopathy.
The potential short-term benefit needs to be considered against these limitations.
Platelet-Rich Plasma (PRP)
Platelet-rich plasma, or PRP, has been studied as a treatment for persistent tennis elbow.
Research findings are mixed, and results vary between studies. PRP should therefore not be presented as a guaranteed method of tendon healing.
It may be considered in selected patients after discussion of:
- The duration and severity of symptoms
- Previous rehabilitation
- Imaging findings where relevant
- Other treatment options
- Cost
- Limitations and uncertainties in the available evidence
Rehabilitation remains important regardless of whether an injection is performed.
Ultrasound-Guided Injections
When an injection is considered, ultrasound can be used to visualise the common extensor tendon and surrounding anatomy and guide treatment to the intended location.
The decision to perform an injection should still be based on the overall clinical assessment rather than the ultrasound appearance alone.
Why Has My Tennis Elbow Not Improved?
Tennis elbow can sometimes persist for many months.
Possible reasons include:
- Continued excessive loading of the tendon
- An inadequate or poorly progressed rehabilitation programme
- Chronic tendon degeneration
- Associated tendon tearing
- An incorrect initial diagnosis
- Another source of lateral elbow pain
- Associated joint or ligament pathology
- Returning to demanding activity faster than the tendon can tolerate
When symptoms remain significant despite treatment, reassessment may be more useful than simply repeating the same treatment.
The diagnosis, rehabilitation programme and any imaging should be reviewed before deciding on further intervention.
When Is Surgery Considered for Tennis Elbow?
Only a minority of patients with tennis elbow require surgery.
Surgery may be considered when there is:
- Persistent pain despite appropriate non-operative treatment
- Significant limitation of work, sport or everyday activities
- A diagnosis consistent with persistent common extensor tendon pathology
- Failure to make satisfactory progress with an appropriate rehabilitation programme
- A reasonable expectation that surgery can address the source of symptoms
The decision should not be based simply on the number of months that symptoms have been present.
What Does Tennis Elbow Surgery Involve?
For selected patients with persistent tennis elbow that has not improved adequately with appropriate non-surgical treatment, surgery may be considered.
Dr Puah performs arthroscopic common extensor origin repair for selected cases of persistent tennis elbow.
During elbow arthroscopy, a small camera is introduced into the elbow joint through keyhole incisions. This allows the joint to be assessed for associated pathology that may also contribute to lateral elbow pain.
The abnormal portion of the common extensor tendon is identified and treated, and the common extensor origin is repaired back to its attachment.
An arthroscopic approach also allows assessment of other structures within the elbow joint where clinically relevant.
Surgery is not required for most patients with tennis elbow. Before considering an operation, it is important to confirm that the symptoms are consistent with common extensor tendon pathology and to assess for other possible causes of persistent lateral elbow pain.
→ Learn more about Elbow Arthroscopy
How Long Does Tennis Elbow Take to Recover?
Recovery varies considerably between patients.
Many cases improve gradually over several months rather than within a few days or weeks.
The recovery period depends on factors including:
- Duration of symptoms
- Severity of tendon involvement
- Occupational demands
- Sporting activities
- Rehabilitation
- Associated elbow pathology
- Individual response to treatment
Improvement in pain does not necessarily mean that the tendon is immediately ready to tolerate its previous workload.
Progressive strengthening and gradual restoration of activity are therefore important.
Can I Continue Exercising With Tennis Elbow?
Often, yes.
It may not be necessary to stop all exercise or sport.
Instead, activities that significantly aggravate symptoms can be modified while rehabilitation is undertaken. Training can then be progressively increased as pain, strength and tendon capacity improve.
The appropriate level of activity differs between individuals.
Returning to Tennis, Golf and the Gym
Return to sport should be based on function rather than simply waiting for a predetermined number of weeks.
Important considerations include:
- Pain during and after activity
- Grip strength
- Wrist-extensor strength
- Ability to tolerate repeated loading
- Sport-specific technique and demands
For racquet sports, equipment, grip size, technique and sudden changes in training volume may also need to be considered.
Gym exercises can often be modified rather than stopped completely.
A gradual increase in load is generally preferable to an abrupt return to previous training levels.
→ Learn more about Return to Sport After Injury
Frequently Asked Questions About Tennis Elbow
Does tennis elbow only occur in tennis players?
No.
Tennis elbow commonly occurs in people who do not play tennis. Any activity involving repeated gripping, wrist extension or forearm loading can contribute.
Will tennis elbow heal by itself?
Many cases improve over time, particularly when aggravating loads are addressed appropriately.
Persistent symptoms may benefit from assessment and a structured rehabilitation programme.
Should I completely rest my arm?
Usually not.
Temporary modification of aggravating activities may help, but prolonged complete rest can result in loss of strength and does not address the tendon’s ability to tolerate load.
Is tennis elbow inflammation?
The traditional term “lateral epicondylitis” suggests inflammation, but persistent tennis elbow is better understood as a tendinopathy involving structural and biological changes within the tendon rather than simply ongoing acute inflammation.
Do I need an MRI?
Not routinely.
Most cases can be diagnosed clinically. MRI may be considered when symptoms are persistent or atypical, another condition is suspected, or surgery is being considered.
Does a steroid injection cure tennis elbow?
Corticosteroid injection may provide short-term pain relief, but it does not necessarily improve long-term outcome and recurrence can occur.
Treatment should therefore not rely solely on repeated corticosteroid injections.
Does PRP cure tennis elbow?
PRP is not a guaranteed cure.
Studies have produced mixed results. It may be considered for selected patients after discussion of the evidence, alternatives and limitations.
When should I see an elbow specialist?
Assessment may be useful when pain is persistent, interferes with work or sport, is associated with weakness, stiffness, locking or instability, or has not responded as expected to treatment.
Reassessment is particularly useful when there is uncertainty about whether the diagnosis is actually tennis elbow.
Does tennis elbow require surgery?
Usually not.
Surgery is generally reserved for selected patients with persistent, functionally significant symptoms despite appropriate non-operative treatment.
Can tennis elbow come back?
Symptoms can recur, particularly when the tendon is suddenly exposed to loads beyond its current capacity.
Progressive strengthening and gradual return to demanding activities may help reduce this risk.
About Dr Puah Ken Lee
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore whose clinical practice focuses on shoulder, elbow and sports injuries.
His professional background includes:
- Fellowship training in shoulder and upper-limb surgery
- Visiting Consultant at Singapore General Hospital
- Chair, Singapore Shoulder & Elbow Society
- Chair, Chapter of Orthopaedic Surgeons, Academy of Medicine, Singapore
- Corresponding Member of the American Shoulder and Elbow Surgeons
- Member of the Global Elbow Network
- Published research in shoulder and elbow surgery
- Invited faculty teaching elbow surgery at regional and international courses
His elbow practice includes non-operative treatment, ultrasound-guided procedures, elbow arthroscopy, arthroscopic common extensor origin repair, tendon repair and reconstruction, and ligament surgery where appropriate.
Treatment recommendations are based on establishing the diagnosis and determining the least invasive treatment likely to provide meaningful improvement.
Most patients with tennis elbow do not require surgery.
→ Learn more about Dr Puah’s elbow practice
Related Elbow Resources
Tennis Elbow and Elbow Pain
Elbow Procedures
- Elbow Arthroscopy
- Ultrasound-Guided Elbow Injections
Other Causes of Elbow Symptoms
- Golfer’s Elbow
- Elbow Arthritis
- Elbow Stiffness
- Elbow Instability
- Cubital Tunnel Syndrome
Sports and Rehabilitation
Tennis Elbow Assessment at Mount Elizabeth Novena
If you have persistent pain on the outer side of the elbow, an assessment by an elbow specialist can help determine whether the symptoms are due to tennis elbow or another elbow condition and which treatment options may be appropriate.
360 Orthopaedics
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #07-24
Singapore 329563
Dr Puah Ken Lee
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Book an appointment or contact the clinic via WhatsApp to discuss your elbow condition.
Dr Puah is regularly invited to teach elbow surgery internationally
Elbow conditions are common but treatable. Early diagnosis and appropriate management can improve outcomes and prevent long-term problems.
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore specialising in shoulder, elbow and sports injuries at 360 Orthopaedics, Mount Elizabeth Novena. Patients with persistent elbow symptoms are encouraged to seek specialist evaluation.