Tennis elbow: causes, symptoms, treatment, and prognosis.

What is tennis elbow?


Tennis elbow is also called lateral epicondylitis or lateral elbow tendinopathy.


The muscles in the forearm that control wrist extension have a common tendon. This tendon inserts onto the bone at the outside of the elbow.



Lateral elbow tendon pathology can be classified into three categories:

  • Tendonitis is acute inflammation of the tendon. This occurs after an injury or trauma.

  • Tendon tears can occur after severe injuries.

  • Tendinopathy is chronic overuse or overload of the tendon. This usually occurs after prolonged repetitive and overuse activities. Read more about tendinopathy here.


How does tennis elbow occur?


Tennis elbow can occur after high impact activities that cause inflammation of the tendon. People with tendonitis can usually pinpoint a specific activity or injury that triggered the symptoms.


More commonly, tennis elbow results from repeated stress of the common extensor tendons. Pain usually gets worse over the course of days to weeks. Common aggravating activities include racket sports, computer work, machine work, construction, gardening, etc.


Tennis elbow symptoms


Tennis elbow causes pain at the outside of the elbow. It can hurt to extend the wrist and the fingers. Making a fist or gripping objects can aggravate pain. Grabbing and turning a doorknob can also reproduce pain. The pain can radiate down the forearm or up towards the upper arm.


Diagnosis of tennis elbow


Tennis elbow can be diagnosed with a thorough physical exam. Swelling of the elbow may be present. There can be tenderness at the outside bone of the elbow or along the distribution of the common extensor tendon. Strength testing of the elbow and wrist may reproduce pain.


X-rays may be necessary in the setting of injury or trauma to rule out fracture.

Ultrasound can look for inflammation and assess the integrity of the tendon.


Tennis elbow treatment


Initial treatment involves resting and protecting the elbow. Avoid or modify activities that exacerbate pain. Once pain improves, gradually increase physical activity.


Acute pain

  • Icing the area can help reduce pain and swelling. Apply ice 15-20 minutes at a time. Do this every 4 hours for the first two to three days or until pain improves.

  • Oral or topical anti-inflammatory medications can help decrease inflammation and control pain.

  • Prescription nitroglycerin patches can help those with significant pain.


Supportive devices


Persistent symptoms

  • Patients with persistent symptoms may need injections. Many studies have shown that platelet rich plasma injections can significantly help improve tennis elbow symptoms.


Tennis elbow rehabilitation


The goal of rehabilitation is to return to activity as quickly and as safely as possible. Returning too soon can exacerbate symptoms. It can also weaken the tendon and lead to tendon tears.


A home exercise program will help improve range of motion, stability, and strength. Some people choose to participate in physical therapy. Physical therapists assess, guide, and teach you exercises and stretches. They also individualize a training program for you and your body.


Here is a link to a great example of a home exercise program for tennis elbow:

Tennis elbow stretches and exercises


Try to do your home exercise program twice a day. When pain is severe, focus on stretching and range of motion. Include strengthening exercises as pain improves.


Recovery for tennis elbow


Recovery is determined by the duration and severity of the injury. The longer you have symptoms, the longer it will take to get better. Use symptoms as a guide for progression. Avoid using time in days or weeks as a marker for recovery.


Decrease the frequency of your home exercise program as your symptoms improve. For example, if doing the exercises twice a day, decrease to once a day. Do this for about one week.


Many people choose to incorporate these exercises into their weekly workout routine. This can help prevent reinjury as well as maintain strength, mobility, and range of motion.


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Some pictures were taken without permission from the Sports Medicine Patient Advisor. They are intended for educational purposes only.