Tennis Elbow

Tennis elbow (lateral epicondylitis) is a common condition that causes pain and discomfort on the outside of the elbow. It’s a type of tendinitis (inflamed tendons) that can happen when you overuse or strain the tendons that attach the forearm muscles to the outside of the elbow. This overuse causes tiny tears and inflammation in the tendons. 

Tennis elbow affects tennis, pickleball, racquetball and squash players who use backhand strokes. Playing other sports that stress your arms, like golf, baseball, softball, bowling or weightlifting, can also lead to tennis elbow. But anyone who strains the forearm muscles could develop the condition. 

You’re more likely to get tennis elbow if you perform repeat motions with your arms, wrists or hands, like typing, painting or heavy lifting. It’s common in people who grip something while repeatedly moving their elbow.

Causes and risk factors of tennis elbow

The main cause of tennis elbow is overuse. When you repeatedly move and stress the forearm muscles and tendons, especially when you’re gripping something or extending your wrist, you can get small tears in the tendon tissue. 

Jobs that require repeat hand motions may put you at higher risk of developing tennis elbow. These include:

• Plumbers, carpenters, mechanics or painters, who often use repetitive arm movements.
• Musicians who play string or keyboard instruments.
• Office workers who spend a lot of time typing or using a computer mouse.
• Cooks, chefs and butchers, who chop a lot.
• Dentists and surgeons, who grip and move instruments.

Smoking, obesity and some medications may also increase your risk. The condition is most common in people aged 30 to 60, but you’re at risk if you often use your forearm muscles, regardless of your age. You may also get tennis elbow with no obvious cause.

Signs and symptoms of tennis elbow

Lateral epicondylitis symptoms usually develop slowly. At first, you might notice mild discomfort. If you keep overusing your tendon, symptoms are likely to get worse. You may notice:

• Elbow pain and tenderness: Aching or burning in the outside part of the elbow, near the bony knob, especially when you lift objects or twist your forearm. The pain may feel like it spreads down your arm toward your wrist.
• Wrist pain: Pain that gets worse with activities like turning a doorknob or holding a cup of coffee or a pen.
• Weak grip strength: Trouble grasping objects firmly.
• Stiffness: Your elbow may feel stiff or hard to move in the morning.
• Burning: A burning feeling on the outside of the elbow that may reach down the forearm.

If you notice these symptoms for more than a few weeks or if they affect your daily activities, consult a health care provider.

Conditions that may be mistaken for tennis elbow

These other conditions can cause pain around the elbow:

• Radial tunnel syndrome: When the radial nerve in the forearm is compressed, it causes pain like tennis elbow but typically further down the arm.
• Elbow arthritis: Arthritis in the elbow joint can cause swelling, stiffness and pain. Unlike tennis elbow, arthritis-related pain may happen even without specific movements.
• Cervical radiculopathy: Issues in the cervical spine, like a herniated disc, can pinch nerves and lead to radiating pain down the arm.
• Golfer’s elbow: Golfer’s elbow (medial epicondylitis) can cause pain in the elbow but the pain is located on the inside, not the outside.

How is lateral epicondylitis diagnosed?

To diagnose tennis elbow, your health care provider may:

• Ask about your symptoms, medical history, job, hobbies and physical activity.
• Perform a physical exam to check for tenderness and look for any trouble with your range of motion.
• Recommend imaging tests such as X-rays to rule out arthritis or fractures and MRI or ultrasound to show any soft tissue damage like tendon tears or swelling.
• Suggest an electromyography (EMG) test to check for nerve problems in your elbow.

Treatment options for tennis elbow

There are several ways to treat lateral epicondylitis. It can take a few months for you to recover, depending on how much damage there is to the tendon and what caused it. Options include:

• Rest and activity modification: The first steps in treatment are resting your arm, avoiding activities that make the pain worse and modifying how you do tasks, so you don’t put more strain on the elbow.
• Therapy: A physical, occupational or hand therapist can teach you exercises that stretch and strengthen the muscles in your forearm and your tendons. Techniques like manual therapy may also improve healing. Therapists can also help you modify the way you perform tasks or exercise.
• Pain management: Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) can reduce pain and inflammation. Applying ice packs to the elbow for 15 to 20 minutes a few times a day may help reduce pain and swelling.
• Bracing and supports: A forearm strap, wrap, tape or brace can lower pressure on the tendon and improve symptoms.
• Corticosteroid injections: Injecting anti-inflammatory medication directly into the elbow can reduce pain.
• Shock wave therapy: This type of ultrasound may improve blood flow, which helps you heal.
• Needle fenestration or ultrasonic tenotomy: These techniques use needles to help heal your tendon.
• Surgical options: In severe cases, you may need surgery to remove damaged tissue. Surgery is usually only considered if other treatments haven’t worked for six to 12 months. If you do need surgery, your provider will remove the damaged tissue and repair the tendon. Most people go home the same day.

Self-care and prevention

After symptoms improve, you can take these steps to help keep tennis elbow from coming back:

• Make sure your workstation is set up to minimize strain on your wrist and elbow.
• Perform forearm stretching and strengthening exercises.
• If your hobbies or work involve repeat arm movements, take breaks or use different techniques to reduce stress on your elbow.
• Warm up before sports or activities that use your arm and give yourself time to recover between workouts.
• If you play tennis or another racquet sport, make sure you use the right racquet and technique.
• Use lighter tools, racquets or equipment with larger grips.

Getting care

Be sure to contact a health care provider if:

• Your symptoms aren’t getting better with home care.
• Your pain becomes severe, persistent or worse even if you rest your arm.
• You have swelling, numbness or a change in the color of your elbow or forearm.
• You have weakness that limits your daily activities.

At Banner Health, our specialists are experienced in diagnosing and treating tennis elbow. Our comprehensive approach includes state-of-the-art imaging technology, personalized physical therapy programs and advanced treatment options. We’re committed to helping you get back to doing what you love, without pain.