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Tennis Elbow: Causes, Symptoms and Treatment
Tennis elbow is a painful overuse condition affecting the tendon attachments on the outer bony prominence of the elbow. It is commonly caused by repetitive arm and wrist movements.
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Tennis elbow is a painful overuse condition affecting the tendon attachments on the outer bony prominence of the elbow. It is commonly caused by repetitive arm and wrist movements.
What is Tennis Elbow?
Tennis elbow (medical term: lateral epicondylitis) is a painful condition caused by overuse of the forearm muscles and tendons that attach to the lateral epicondyle – the bony bump on the outside of the elbow. Despite its name, tennis elbow does not only affect tennis players. It is a common complaint among people who perform repetitive arm movements at work or during daily activities.
Causes
The primary cause is repetitive strain on the extensor muscles of the forearm, leading to micro-tears and degeneration at the tendon insertion point. Common triggers include:
- Playing racket sports, especially tennis (particularly backhand strokes)
- Manual work such as painting, plumbing, or carpentry
- Prolonged computer or mouse use
- Lifting heavy objects with an extended elbow
- Gardening tasks such as hedge trimming or raking
In rare cases, a single traumatic event such as a direct blow to the elbow can also trigger the condition.
Symptoms
Symptoms typically develop gradually and may worsen over weeks or months. Common signs include:
- Pain on the outer side of the elbow, sometimes radiating down the forearm
- Tenderness directly over the lateral epicondyle
- Pain when extending the wrist or gripping objects
- Weakness when holding everyday items (e.g., a cup, a doorknob)
- Worsening pain with activity and relief at rest
Diagnosis
Diagnosis is primarily clinical, based on patient history and physical examination. Key diagnostic tests include:
- Thomsen test: Pain provoked by extending the wrist against resistance
- Chair test: Pain when lifting a chair with an extended elbow and palm facing downward
Imaging studies may be used to confirm the diagnosis or rule out other conditions:
- Ultrasound: To visualize tendon changes and micro-tears
- MRI (Magnetic Resonance Imaging): For detailed assessment in unclear cases or suspected tendon rupture
- X-ray: To exclude bone abnormalities or calcifications
Treatment
Conservative Treatment
The vast majority of cases resolve with non-surgical management. Recommended approaches include:
- Rest and activity modification: Avoiding movements that trigger pain
- Physiotherapy: Strengthening and stretching exercises for the forearm muscles
- Counterforce brace (epicondylitis clasp): Reduces strain on the tendon attachment
- Pain relief and anti-inflammatory medication: NSAIDs such as ibuprofen or diclofenac (oral or topical)
- Shockwave therapy: Promotes tissue healing through acoustic energy
- Corticosteroid injections: Provide short-term pain relief but should be used cautiously
Surgical Treatment
If conservative treatment fails after 6–12 months, surgery may be considered. The procedure involves removing degenerated tendon tissue and releasing the attachment point to reduce strain and promote healing.
Prevention
To reduce the risk of developing tennis elbow, the following measures are recommended:
- Warm up and stretch before physical activity or sport
- Use ergonomic equipment and correct technique in sport and at work
- Strengthen forearm muscles through regular targeted exercises
- Ensure correct racket grip size and playing technique in racket sports
References
- Bisset L, Beller E, Jull G et al. - Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow. BMJ, 2006; 333(7575): 939.
- Shiri R, Viikari-Juntura E - Lateral and medial epicondylitis: role of occupational factors. Best Practice & Research Clinical Rheumatology, 2011; 25(1): 43–57.
- National Institute for Health and Care Excellence (NICE) - Tennis elbow: clinical overview, 2022. Available at: www.nice.org.uk
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