Tennis elbow, or lateral epicondylitis, is a type of elbow tendinopathy caused by overuse of the forearm muscles. It affects the area where this muscle attaches to the outside of the elbow (the lateral epicondyle of the elbow joint).
The main symptom of tennis elbow is pain and tenderness around the outer elbow, which may spread to the forearm and wrist, making it hard to grip or lift objects. It’s common in tennis players and others who repeat the same arm movements.
The causes of tennis elbow include repeated strain and small injuries to the elbow tendons.
The muscle region affected by tennis elbow © Andrea Danti | AdobeStock
Tennis elbow, or lateral epicondylitis, is one of the most common elbow injuries in tennis players. It affects more men than women, typically between ages 35 and 55, and is often caused by overuse of the forearm muscles and strain on the lateral epicondyle.
Tennis elbow causes localized pain when pressure is applied to the lateral epicondyle of the humerus. The pain can be triggered in particular when closing the fist. Those affected therefore find it difficult or impossible to grip firmly.
There is also pain when extending the wrist against resistance with the elbow extended.
To diagnose tennis elbow, a physical exam is used to assess symptoms like pain around the outside of the elbow and weakness in the wrist and elbow. Since tennis elbow symptoms can resemble other conditions—such as medial epicondylitis, supinator syndrome, or swelling of the tendons—imaging tests like MRI or ultrasound may be recommended to rule out other causes.
In some cases, changes in the cervical spine or irregularity of the lateral epicondyle may contribute to chronic tennis elbow. A physical therapist or specialist in sports medicine will consider these factors when planning the treatment of lateral epicondylitis.
The treatment of tennis elbow is divided into conservative and surgical treatment.
At the beginning of the disease, conservative therapy is used. The aim is to reduce the inflammatory reaction at the tendon insertion of the affected muscle. The following procedures are recommended in combination with each other:
- Rest.
- Stretching of the extensors.
- Ultrasound.
- Iontophoresis and electrotherapy.
- Transverse friction of the tendon insertion.
- Compression with bandages (epicondylitis bandages).
- Local injections, e.g. with cortisone.
- General measures such as modification of the tennis racket.
For persistent tennis elbow symptoms, options like brace support, anti-inflammatory medications, or shockwave therapy may help. In some cases, extracorporeal shockwave therapy or platelet-rich plasma injections are used to increase blood flow and promote healing.
If symptoms don’t improve, tennis elbow surgery—either arthroscopic or open surgery—may be considered to repair damaged tissue. While surgery is rarely needed, it can be effective for chronic tennis elbow when other treatments fail.
Early management of lateral elbow tendinopathy and proper care can translate into pain relief and avoid long-term issues. The best treatment approach depends on symptoms, activity level, and overall health.
After tennis elbow repair, recovery includes wound checks and physical therapy to restore strength in the elbow and arm. Whether treated with open surgery or arthroscopic surgery, healing takes time. The forearm and elbow must gradually regain function, especially where the extensor carpi radialis brevis tendon attaches to the bone. Full rehab can take up to six months, depending on the activity that causes strain and the chosen best treatment approach.
For patients with lateral epicondylitis, conservative care is often effective. The pain of tennis elbow usually improves with rest, bracing, and extracorporeal shock wave therapy, making it the best treatment approach for most. Since tennis elbow is often caused by overuse, surgery is only needed when symptoms and causes persist despite treatment. People who get tennis elbow—even those who don’t play tennis—can recover well with proper management of lateral epicondylitis.
