Tennis Elbow (Lateral Epicondylitis) Treatment in Singapore: A Complete, Evidence-Based Care Pathway

Outer Elbow Pain — Why It Persists With Daily Use

Tennis elbow (lateral epicondylitis) is a condition involving the tendons on the outside of the elbow, commonly caused by overuse.

It may present as:

  • Pain on the outer elbow
  • Pain when gripping or lifting
  • Weak grip strength
  • Discomfort during repetitive hand or wrist movements

Despite its name, it is not limited to athletes. It commonly affects:

  • Office workers
  • Manual workers
  • Individuals performing repetitive arm movements

Many people try rest or massage, but symptoms can persist without a structured plan.

What Evidence-Based Guidelines Recommend

Clinical guidelines and consensus recommend a stepwise, conservative-first approach:

  1. Clinical diagnosis (imaging when needed)
  2. Exercise-based rehabilitation and load management
  3. Medication for symptom control
  4. Adjunct therapies (e.g., shockwave)
  5. Injection therapy in selected cases
  6. Surgical referral when necessary

The Pain Relief Clinic aligns its care model with this pathway.

1. Diagnosis First: Confirming the Source of Pain

Elbow pain may arise from:

  • Tendinopathy (most common)
  • Ligament strain
  • Nerve irritation
  • Joint-related conditions

At The Pain Relief Clinic:

  • Clinical assessment is performed
  • Imaging such as ultrasound or MRI may be arranged within 1 working day when appropriate

This helps ensure treatment is directed accurately.

2. Physiotherapy & Rehabilitation: Core Treatment

Guidelines emphasize exercise-based rehabilitation as the mainstay.

Active Rehabilitation

Programmes may include:

  • Eccentric strengthening of wrist extensors
  • Grip strengthening
  • Forearm conditioning
  • Load management strategies
  • Gradual return to activity

These are tailored based on:

  • Severity of symptoms
  • Functional demands
  • Progress over time

Passive Non-Invasive Support

To support recovery:

  • Shockwave therapy (commonly used for tendon-related conditions)
  • Radiofrequency-based deep tissue therapy
  • Manual therapy where appropriate

These may help reduce pain and support tendon healing.

Integrated Physiotherapy (Key USP)

  • Physiotherapists are MOH AHPC-licensed
  • Rehabilitation is closely coordinated with the doctor
  • Programmes are adjusted based on diagnosis and response

3. Medication: Supporting Symptom Control

Medication may be used to:

  • Reduce pain
  • Improve function
  • Enable participation in rehabilitation

First-Line Options

  • Paracetamol
  • Topical NSAIDs
  • Oral NSAIDs

Second-Line / Subsequent Options

  • COX-2 inhibitors
  • Short-term oral opioids (used cautiously)

Medication is:

  • Typically short-term
  • Used alongside rehabilitation
  • Not intended as a standalone long-term solution

4. Injection Options for Persistent Tendon Pain

When symptoms persist despite conservative care:

Local Anaesthetic Injections

  • Temporary pain relief
  • May help confirm diagnosis

Corticosteroid Injections

  • May provide short-term pain relief
  • Used selectively due to potential long-term tendon effects

PRP (Platelet-Rich Plasma)

  • Considered in selected chronic cases
  • Evidence is evolving

Pulsed Radiofrequency

  • May be used for chronic pain modulation

Injection therapy is generally:
👉 Used when rehabilitation alone is insufficient

5. Integrated, Team-Based Care

Tennis elbow often benefits from coordinated management.

At The Pain Relief Clinic:

  • Care is led by Dr. Terence Tan, a licensed medical doctor (SMC)
  • With over 20 years of clinical experience
  • Working closely with in-house AHPC-licensed physiotherapists

Treatment plans are adjusted based on:

  • Diagnosis
  • Functional progress
  • Response to therapy

6. Load Management & Activity Modification

Tennis elbow is closely related to:

  • Repetitive strain
  • Overuse of wrist extensors
  • Poor technique or ergonomics

Management may include:

  • Adjusting activity levels
  • Ergonomic corrections
  • Gradual return to work or sports

These help reduce recurrence and support recovery.

7. When Is Surgery Considered?

Surgery may be considered when:

  • Symptoms persist despite prolonged structured care
  • Pain significantly affects function
  • Conservative and injection therapies have not been effective

In such cases, The Pain Relief Clinic:

  • Provides assessment and imaging
  • Refers patients to orthopaedic specialist partners
  • Coordinates care before and after surgery

Common Causes of Tennis Elbow

  1. Repetitive wrist extension
  2. Overuse from work or sports
  3. Poor ergonomics
  4. Weak forearm muscles
  5. Sudden increase in activity
  6. Improper lifting technique
  7. Manual labor
  8. Racquet sports
  9. Prolonged gripping
  10. Combined mechanical factors

When Should You Seek a Structured Approach?

You may benefit from coordinated care if:

  • Elbow pain persists for weeks
  • Grip strength is reduced
  • Pain affects work or daily tasks
  • Symptoms recur repeatedly
  • You are considering injections

Final Takeaway

Tennis elbow is best managed through a structured pathway:

  1. Accurate diagnosis
  2. Targeted physiotherapy and load management
  3. Medication for symptom control
  4. Adjunct therapies such as shockwave
  5. Injection therapy in selected cases
  6. Surgical referral when appropriate

The Pain Relief Clinic provides these components in an integrated, coordinated, and evidence-aligned manner, supporting recovery at each stage.

FAQ

Q1: How long does tennis elbow take to heal?
Recovery varies but may take weeks to months depending on severity and treatment.

Q2: Is shockwave therapy useful?
It is commonly used as an adjunct for tendon-related conditions.

Q3: Do I need an MRI?
Not always, but imaging may help if symptoms are persistent or unclear.

Q4: Can tennis elbow come back?
Yes, especially if contributing factors are not addressed.

Ask Dr Tan A Question About Your Problem