Tennis Elbow


Tennis elbow (Lateral Epicondylitis) is an elbow pain that primarily involves the inflammation of the tendons that join the muscles outside the elbow. These tendons are rugged bands of connective tissue that anchor muscles to bones.

The specific muscle-tendon area typically affected in tennis elbow is where the muscles of the forearm (that extend the wrist and fingers) attach to a bony bump called the lateral epicondyle.

This condition usually develops over time from repetitive forearm motions, such as swinging a tennis racket or a hammer, which can strain the muscles and put too much stress on the tendons. That stress can cause microscopic tears in the tissue, leading to pain and inflammation.

Symptoms usually include pain and tenderness on the outer part of the elbow, which may extend into the forearm and wrist. It can lead to a weakening of grip strength as well.

A steroid injection may be recommended to further reduce inflammation in more severe cases
Photo Credit: Canva

Although this condition is common among tennis players (hence the name), it can occur with any activity that involves repetitive use of these forearm muscles. For example, it can be seen in people who do a lot of typing, knitting, painting, or even lifting, and it can affect people of all ages.

The primary treatments for tennis elbow are rest, physical therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.

If these treatments are unsuccessful, other options may include steroid injections or even surgery in severe cases. However, most tennis elbow patients recover with conservative treatment, especially if treatment is sought promptly after symptoms develop.

What are the Causes of Tennis Elbow?

Primarily, tennis elbow is caused when the elbows are overloaded or by overuse of the muscles and tendons in the forearm. Specifically, tennis elbow affects the extensor carpi radialis brevis (ECRB) muscle, which helps to stabilize the wrist.

Performing repetitive motions, such as gripping a tennis racket, using a screwdriver, or even typing on a keyboard, can strain the ECRB muscle and lead to inflammation and microtears in the tendon.

What are the Symptoms of Tennis Elbow?

Tennis elbow, also known as lateral epicondylitis, is a painful condition characterised by lateral elbow pain. The main symptom is pain in the outer elbow, which may transmit down the forearm. This pain is located around the bony prominence called the lateral epicondyle.

Lifting weight
Photo: Pressmaster | Envato

Activities that involve gripping or lifting can exacerbate the pain. Additionally, weakness in the affected arm and difficulty straightening the elbow are common symptoms, according to Mayo Clinic.

The gradual onset of pain is typical in tennis elbow, and continued activity can worsen the discomfort. If you experience these symptoms, it is essential to seek medical advice, as early intervention can help manage and treat tennis elbow effectively.

How is Tennis Elbow Treated?

Tennis elbow (lateral epicondylitis) can usually be treated with non-surgical methods aimed at reducing pain and swelling. Resting and avoiding activities that worsen the pain is the first line of treatment.

Applying ice to the affected area, and taking rest and over-the-counter pain medications can help to reduce pain and inflammation.

Physical therapy exercises can also be beneficial in strengthening the muscles of the forearm and improving flexibility. Sometimes shockwave therapy is also used; passing high-frequency sound waves to the elbow.

shockwave therapy is also used; passing of high frequency sound waves to the elbow
Photo Credit: Canva

A steroid injection may be recommended to further reduce inflammation in more severe cases. If non-surgical treatments fail to provide relief, surgical treatment may be considered a last resort option.

Consultation with a specialist, such as a doctor specialising in Shoulder and Elbow surgery, can provide the most appropriate treatment plan based on the severity of the condition.

Is Tennis the Only Sport Associated with Tennis Elbow?

Despite its name, tennis elbow can affect anyone who performs repetitive forearm and wrist motions. Sports such as golf (also see golfer’s elbow), baseball, and racquetball, as well as occupations that require repetitive gripping or lifting, can also lead to developing tennis elbow.

According to the American Journal of Sports Medicine, the term “tennis elbow” or “lawn tennis arm” was officially documented in 1883, accompanied by recommendations for treatment involving rest and compression bandages placed just below the painful area of the forearm. Surprisingly, little has changed in the past 125 years.

What are the Risk Factors For Tennis Elbow?

Several factors can increase the risk of developing tennis elbow. These include age (most commonly affects individuals between 30 and 50 years old), participating in activities that involve repetitive forearm and wrist motions, having a job or hobby that requires repetitive gripping or lifting, and certain underlying medical conditions such as rheumatoid arthritis.

Understanding Tennis Elbow

  • Other names – Lateral epicondylitis, lateral elbow tendinopathy
  • Definition – Irritation of the tendons attaching forearm muscles to the elbow’s outside bony part (lateral epicondyle).
  • Primary Symptom – Pain and tenderness focused on the outside of the elbow. Can radiate down the forearm.
  • Causes – Overuse from repetitive wrist extension and gripping actions through work, sports, or hobbies.
  • Who’s at risk – Middle-aged adults, manual workers, athletes in racket sports.
  • Treatment – Rest, braces, physical therapy, injections, shockwave therapy, surgery.
  • Prognosis – Usually resolves within 1-2 years with proper treatment.

Knowing the typical symptoms and causes of tennis elbow is key to getting properly diagnosed and starting appropriate treatment early.

Causes and Risk Factors for Tennis Elbow

Man cuts plant with gardening scissors in garden
Photo: RossHelen | Envato

The primary underlying cause of tennis elbow is repetitive strain and overuse of the wrist extensor muscles that attach to the outside of the elbow. Specific contributory factors include:

  • Sports – racquet sports like tennis or squash, golf, baseball, swimming
  • Work – manual jobs involving gripping, twisting, and vibrating tools
  • Hobbies – gardening, knitting, carpentry, painting
  • Trauma – Direct injury to the elbow or wrist
  • Improper technique – Poor swing mechanics in sports
  • Existing elbow conditions – Osteoarthritis can increase the risk
  • Age – Most common between ages 30-50

Modifying training techniques, using proper equipment and techniques, and avoiding overuse of the elbow muscles help reduce injury risk.

Signs and Symptoms of Tennis Elbow

The main symptoms include:

  • Outer Elbow pain – Pain focused on the outside of the elbow Worsens with gripping or wrist extension.
  • Tenderness – Specific tender point near the bony prominence on the outside elbow.
  • Weakened grip strength
  • Stiff elbow and restricted range of motion
  • Dull ache radiating down the forearm
  • Pain triggered by simple tasks – Lifting, gripping objects, shaking hands.
  • Elbow clicking or popping
pain is located around the bony prominence called the lateral epicondyle
Photo Credit: Canva

Symptoms develop gradually over weeks or months as muscle strain builds up. Pain often persists for extended periods, even at rest. Seeking treatment early provides the best results.

How is Tennis Elbow Diagnosed?

Tennis elbow diagnosis typically involves:

  • Medical history – Occupation, sports participation, trauma, pain description
  • Physical exam – Locating tender points, testing grip and wrist strength
  • Imaging – X-rays or magnetic resonance imaging (MRI) rule out other elbow conditions like fracture or arthritis
  • Palpation – Pain when pressing on the lateral epicondyle suggests tennis elbow

Reproducing pain with resistance against wrist extension movement can aid in diagnosis. Make sure other causes of elbow pain are ruled out.

Conventional Tennis Elbow Treatments

woman resting at home for tennis elbow
Photo: choreograph | Envato

Most cases of tennis elbow are treated non-surgically. Typical treatments aim to alleviate pain and allow healing of the strained tendons:

  • Rest – Avoid aggravating activities to rest the elbow.
  • Ice – Applying ice packs to reduce inflammation and pain.
  • Pain relievers – Anti-inflammatories drugs like ibuprofen help relieve symptoms.
  • Elbow brace – Bracing or taping the elbow provides support and strain relief.
  • Physical therapy – Stretching, strengthening, and massage help heal tissues.
  • Platelet-rich plasma injections – Concentrated platelets accelerate healing. Multiple injections are given.
  • Corticosteroid injections – Powerful anti-inflammatories reduce pain short term but are controversial.
  • Shock wave therapy – Pulsed acoustic waves applied to stimulate healing.
  • Surgery – Rarely required for severe refractory cases unresponsive to other treatments.

Trying conservative treatments first for several months is recommended. Avoid steroid overuse which can weaken tendons.

Emerging Treatments for Tennis Elbow

For stubborn tennis elbow cases, potential emerging treatments currently being researched include:

  • Autologous blood injections – Injecting a patient’s own blood to begin healing factors.
  • Prolotherapy – Injecting irritant agents to stimulate tissue regeneration.
  • Stem cell injections – Showing promise from early trials, but more evidence needed.
  • Botulinum toxin – Weakens overactive muscles; further study is underway.
  • Tenex procedure – Using ultrasound to remove damaged tissue.
  • Laser therapy – Low-level laser light applied over tender points.
  • Nanotechnology – Applying nanoparticles to reduce inflammation.

Tennis Elbow Exercises and Stretches

Specific exercises can help rehabilitate tennis elbow:

  • Wrist curl – Curling hand up with palm facing upwards using a light dumbbell.
  • Wrist extension – With palm down, extend wrist up and back using a resistance band.
  • Forearm pronation/supination – Slowly rotate forearm palm up and down with hand weight.
  • Flexor stretch – With arm extended, palm down, pull fingers back with another hand.
  • Massage – Massage outside elbow and upper forearm muscles.

Starting gentle exercises after the acute pain phase helps regain strength and mobility. Avoid overexerting healing tissues.

Prevention Tips

Here are several strategies to prevent Tennis Elbow:

  1. Proper Technique and Form: This is key, especially when participating in sports like tennis or activities that involve repetitive motion. Instructions on the correct technique can reduce the strain on your muscles and tendons.
  2. Strength and Conditioning: Strengthening your forearm muscles can help reduce the risk of tennis elbow. Exercises targeting these muscles can help them withstand stress and repetitive use better.
  3. Warm Up and Stretch: Before any physical activity, particularly those involving your arms, it’s crucial to warm up properly and stretch. This prepares your muscles and tendons for the upcoming activity.
  4. Use the Right Equipment: Using suitable equipment for your ability, body size, and body strength can help prevent tennis elbow. For instance, tennis players should use a racket with the correct grip size. Also, using a racket with more flexibility may reduce the stress on the forearm.
  5. Rest: Regular breaks from repetitive activities allow your muscles and tendons to rest. This is especially important if you start to feel any pain in the outer part of your elbow.
  6. Ergonomic adjustments: If your work involves repetitive motions, consider speaking to an occupational or physical therapist for advice on how to reduce strain. You may need to adjust your workstation, chair height, or the way you perform certain tasks.
  7. Use of Protective Gear: Use supportive straps or braces on your forearm to alleviate stress on the elbow if you’re involved in activities that could cause tennis elbow.

Remember that while these steps can significantly reduce your risk, they may not prevent all cases of tennis elbow. If you start to notice pain in your elbow, don’t ignore it. Early intervention can help prevent it from becoming a chronic issue.

Awareness of early elbow pain and addressing it quickly helps avoid chronic long-term cases requiring more interventions.

Long-Term Outlook

tennis elbow is caused when elbows are overloaded or by overuse of the muscles and tendons in the forearm.
Photo Credit: Canva

With appropriate conservative treatment, most cases of tennis elbow resolve within 1-2 years. Only about 10-20% of people have persistent long-term pain and disability. Recurrence is common without correcting the underlying causes.

Seeking treatment early optimises the chances of full recovery and reduces the likelihood of complications like tendon tears.

Being patient through the gradual healing process and rehabilitating properly prevents re-injury. New emerging therapies provide hope for better outcomes reducing pain and disability for patients with chronic tennis elbow.

Frequently Asked Questions About Tennis Elbow (FAQs)

What is the fastest way to cure tennis elbow?

The fastest way to treat tennis elbow is to stop activities causing strain, ice the elbow, use anti-inflammatory medication, wear a brace, and get a corticosteroid injection to reduce inflammation and pain quickly.

How do I get rid of my tennis elbow?

Ways to get rid of tennis elbow include resting the elbow, icing, over-the-counter pain relievers, wearing an elbow brace, physical therapy exercises, platelet-rich plasma injections to stimulate healing, and shockwave therapy.

What triggers tennis elbow?

Overuse from repetitive gripping motions and wrist extension triggers tennis elbow. Racquet sports, manual work, gardening, and trauma can overstrain the elbow tendon.

How do you know if you have tennis elbow or tendonitis?

Tennis elbow causes pain focused on the bony area outside the elbow, while tendonitis causes diffuse forearm pain. Pain from tennis elbow also increases with wrist extension.

Tennis Elbow: What it is, Causes, Symptoms & Treatment

Tennis elbow, also known as lateral epicondylitis. The pain of tennis elbow occurs on the outside of your elbow. It is called tennis elbow because it is commonly associated with playing tennis but can also occur in other activities. The pain of tennis elbow occurs primarily when the tendons that attach to the lateral epicondyle of the elbow joint are damaged or torn.

What are the causes of tennis elbow?

Repetitive strain injury to the forearm’s extensor carpi radialis brevis muscle typically causes tennis elbow. This muscle is responsible for extending and stabilising the wrist. Overuse or repetitive motions, such as those commonly found in tennis or other activities that require repetitive gripping and twisting of the forearm, can lead to tennis elbow. It can also occur from sudden or forceful wrist or arm movements.

What are the symptoms of tennis elbow?

The main symptom of tennis elbow is pain on the outside of the elbow. The pain may radiate down the forearm and become worse with lifting, gripping, or twisting activities. Other symptoms may include weakness in the affected arm, difficulty gripping objects, and stiffness in the elbow joint.

How is tennis elbow diagnosed?

Diagnosing tennis elbow usually involves a physical examination and a discussion of your symptoms and medical history. Your doctor may also order imaging tests, such as an X-ray or MRI, to rule out other conditions that may be causing your symptoms.

How long does it take to recover from tennis elbow?

Treatment for tennis elbow typically begins with conservative measures such as rest, ice, physical therapy, and over-the-counter pain medications. Your doctor may also recommend using a brace or splint to help support the affected arm and reduce inflammation. If conservative treatments do not provide relief, your doctor may suggest a steroid injection to reduce pain and inflammation. In severe cases, surgery may be necessary to repair tears in the tendon and relieve symptoms.
The recovery time for tennis elbow can vary depending on the severity of the condition and the individual’s response to treatment. Symptoms often improve with conservative measures within a few weeks to a few months. However, complete recovery may take several months or even longer, especially if surgery is required.

Can tennis elbow be prevented?

While preventing tennis elbow completely may not be possible, you can take steps to reduce your risk. These include using proper technique and equipment when participating in activities that involve repetitive use of the forearm and wrist.