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Tennis Elbow – Causes, Symptoms and Treatment

Tennis elbow is a painful condition caused by overuse of the tendons at the outer elbow. It is common among athletes and people performing repetitive arm movements.

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Things worth knowing about "Tennis Elbow"

Tennis elbow is a painful condition caused by overuse of the tendons at the outer elbow. It is common among athletes and people performing repetitive arm movements.

What Is Tennis Elbow?

Tennis elbow, medically known as lateral epicondylitis or epicondylitis humeri radialis, is a painful condition affecting the outer side of the elbow. It involves irritation or inflammation of the tendon attachments of the forearm extensor muscles at the lateral epicondyle of the humerus – a bony prominence on the outer part of the upper arm bone. Despite its name, tennis elbow frequently occurs in people who have never played tennis.

Causes

The condition is caused by repetitive overuse of the forearm muscles, particularly through repetitive wrist and forearm movements. Common triggering activities include:

Playing tennis (especially backhand strokes with poor technique)
Manual work such as screwing, hammering, or sawing
Office work involving intensive mouse and keyboard use
Gardening or work with vibrating tools

Chronic overloading leads to small tears in the tendon tissue (microtraumas), resulting in a disrupted healing response and degenerative changes in the tendon.

Symptoms

The hallmark symptom of tennis elbow is pain on the outer side of the elbow, which can radiate into the forearm or hand. Other common complaints include:

Pain when gripping, rotating the forearm, or lifting objects
Tenderness directly at the lateral epicondyle
Reduced grip strength
Morning stiffness around the elbow
Pain that worsens with activity and improves with rest

Diagnosis

The diagnosis is usually made clinically, based on the medical history and a physical examination. Typical clinical tests include:

Thomson test: Pain when extending the wrist against resistance
Chair test: Pain when lifting a chair with an extended arm
Middle finger extension test: Pain when extending the middle finger against resistance

Imaging methods such as ultrasound or MRI (magnetic resonance imaging) are used in unclear cases or when planning treatment, and can reveal tendon changes, tears, or signs of inflammation.

Treatment

Conservative Therapy

In most cases, tennis elbow heals with conservative treatment. The following measures are recommended:

Rest and load reduction: Avoiding the activities that trigger the condition
Physiotherapy: Stretching and strengthening exercises, eccentric training of the forearm muscles
Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac as gel or tablet
Icing: Local application of cold for pain relief
Epicondylitis brace (counterforce brace): To reduce pressure on the tendon attachments
Shockwave therapy: Particularly effective for chronic cases

Injection Therapy

For severe pain, corticosteroid injections can provide short-term relief; however, repeated use is associated with an increased risk of relapse. Newer approaches such as platelet-rich plasma (PRP) injections show promising results in studies for chronic cases.

Surgical Treatment

Surgery is only considered in rare cases – when conservative treatment has not been successful after 6–12 months. The procedure involves removing degeneratively altered tendon tissue and reconstructing the tendon attachments.

Prognosis and Outlook

Tennis elbow generally has a good prognosis. With consistent treatment and avoidance of overloading, most cases heal completely within a few months to a year. Adjusting movement patterns and work techniques is important to prevent recurrence.

References

Shiri R, Viikari-Juntura E: Lateral and medial epicondylitis: role of occupational factors. Best Practice & Research Clinical Rheumatology. 2011;25(1):43–57.
Bisset L, Vicenzino B: Physiotherapy management of lateral epicondylalgia. Journal of Physiotherapy. 2015;61(4):174–181.
Karanasios S et al.: Exercise interventions in lateral epicondylitis: a systematic review with meta-analysis. Journal of Hand Surgery European Volume. 2021;46(3):262–281.

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