What is a Tennis Elbow? Understanding Causes, Symptoms, Treatments, and Prevention

Tennis elbow, medically known as lateral epicondylitis, is a common condition that causes pain and tenderness around the outer part of the elbow. Despite its name, tennis elbow isn’t limited to athletes – it can affect anyone who engages in repetitive wrist and arm movements. This condition develops when the tendons in the elbow become overloaded, leading to tiny tears and inflammation. Over time, this results in pain, reduced grip strength, and difficulty performing simple daily tasks, like lifting objects or turning door knobs. In this blog, we’ll explore tennis elbow, covering its causes, symptoms, treatment options, and prevention strategies to help you better understand and manage this common but often frustrating condition.

What is a Tennis Elbow?

Tennis elbow is a painful condition that occurs when the tendons connecting the forearm muscles to the outer part of the elbow become inflamed or damaged. This is usually caused by repetitive motion or overuse, leading to tiny tears in the tendon, which results in pain and tenderness around the elbow. It can affect anyone who repeatedly uses their forearm muscles, especially in activities that involve gripping, lifting, or twisting motions. Common examples include painters, carpenters, mechanics, chefs, and even office workers who spend long hours typing or using a mouse.

The condition primarily affects the extensor carpi radialis brevis (ECRB) tendon, which helps stabilize the wrist during activities involving the extension of the hand and wrist. Overuse of this tendon can lead to inflammation, weakening, and pain.

Tennis Elbow vs. Golfer’s Elbow

While both conditions involve tendon inflammation around the elbow, they affect different areas:

• Tennis Elbow (Lateral Epicondylitis):
  • Pain is located on the outside of the elbow.
  • Involves the tendons attached to the lateral epicondyle.
• Golfer’s Elbow (Medial Epicondylitis):
  • Pain occurs on the inside of the elbow.
  • Involves tendons attached to the medial epicondyle.

Recognizing this distinction is crucial, as treatment approaches for each condition may vary slightly based on the specific tendons affected.

What Causes Tennis Elbow?

Tennis elbow is primarily caused by overuse and repetitive motion, which place strain on the tendons in the elbow, leading to small tears and inflammation. While athletes who play racquet sports are at risk, the condition is common among people who perform repetitive arm and wrist movements in daily activities or work.

Repetitive Motion and Overuse

The most common cause of tennis elbow is repetitive use of the forearm muscles, particularly when performing gripping, twisting, or lifting actions. Over time, these movements strain the tendons that attach the forearm muscles to the elbow, leading to tiny tears and inflammation.

Common Activities That Can Lead to Tennis Elbow

• Sports-Related Movements:
  • Tennis (especially with improper backhand technique)
  • Squash, badminton, or racquetball
  • Throwing sports like baseball or javelin
• Occupational Risks:
  • Carpentry, plumbing, and painting
  • Repetitive use of tools like screwdrivers or hammers
  • Typing or mouse use for prolonged periods
• Everyday Activities:
  • Lifting heavy grocery bags
  • Gardening or using shears
  • Repetitive gripping or twisting motions (e.g., opening jars)

Risk Factors

Certain factors can increase the likelihood of developing tennis elbow:

• Age: Most common between ages 30 and 50, but it can affect people of all ages.
• Occupation: Jobs that involve repetitive arm motions or heavy lifting carry a higher risk.
• Poor Technique: In sports or work, improper form can put extra stress on the forearm tendons.
• Weak Forearm Muscles: Insufficient muscle strength can cause the tendons to bear more strain.
• Pre-existing Conditions: People with underlying musculoskeletal issues may be more prone to tendon injuries.

Recognizing these causes and risk factors is essential to prevent tennis elbow or catch it early before it becomes a chronic issue.

Common Symptoms of Tennis Elbow

Tennis elbow usually develops gradually, starting with mild discomfort that worsens over time. The pain typically begins on the outer part of the elbow (lateral epicondyle) and can spread down the forearm and into the wrist, especially during activities that involve gripping, lifting, or twisting. Key symptoms of tennis elbow include:

• Pain and Tenderness: A sharp or burning pain on the outer part of the elbow, often worsened by pressing on the area or using the forearm muscles.
• Radiating Pain: Discomfort that spreads from the elbow down the forearm to the wrist, making tasks like turning a doorknob or lifting objects painful.
• Weakened Grip Strength: Difficulty holding items, such as a coffee mug, tools, or even writing instruments, due to reduced grip strength.
• Pain Worsening with Activity: Actions like shaking hands, using a racquet, or twisting objects (e.g., turning keys) can intensify the pain.
• Stiffness and Limited Range of Motion: Some people experience stiffness in the elbow, especially in the morning or after periods of inactivity.

Acute vs. Chronic Tennis Elbow Symptoms 

• Acute Tennis Elbow: Symptoms appear suddenly after a specific injury or intense overuse, often in athletes following rigorous training or matches.
• Chronic Tennis Elbow: Pain and discomfort that persist for more than 6 to 8 weeks. Without treatment, symptoms can worsen, leading to constant pain even during rest.

When to See a Doctor

While mild cases of tennis elbow often improve with rest and home care, certain signs indicate the need for professional evaluation. Early medical attention can prevent long-term damage and promote faster recovery.

Signs That Require Medical Attention

• Persistent Pain: If elbow pain lasts more than 4 to 6 weeks despite rest, ice, and over-the-counter medications, or if it starts interfering with daily tasks and sleep.
• Weakness or Limited Function: Difficulty gripping, lifting, or performing simple tasks like turning a doorknob, along with noticeable weakness in the affected arm.
• Recurring Flare-Ups: Frequent episodes of elbow pain after repetitive activities may signal a chronic issue that requires specialized treatment.
• No Improvement with Conservative Care: If physical therapy, bracing, and medications haven’t improved symptoms after several weeks, advanced treatments like injections or surgery may be needed.

Urgent Situations Needing Immediate Care

• Sudden, Severe Pain: Sharp, intense pain following an impact or strain could indicate a tendon rupture or severe tear.
• Swelling, Redness, and Fever: Though rare, these symptoms may suggest an infection in the elbow joint, which requires immediate medical attention.

Importance of Early Diagnosis

• Prevents Chronic Tendon Damage: Addressing the issue early can stop it from worsening.
• Customized Treatment: A healthcare provider can recommend targeted exercises, therapies, or surgical options based on severity.
• Speeds Up Recovery: Prompt care can help reduce recovery time and prevent long-term complications.

If you’re experiencing persistent discomfort or difficulty performing daily activities, consulting a healthcare professional ensures the right treatment before the condition worsens.

How is Tennis Elbow Diagnosed?

Diagnosing tennis elbow typically involves a combination of a detailed medical history, a physical examination, and, in some cases, imaging tests to rule out other potential causes of elbow pain. Early and accurate diagnosis is essential to develop an effective treatment plan and prevent long-term complications.

Medical History and Symptom Review

The diagnostic process often starts with a review of your symptoms and medical history. Your doctor may ask:

• When the pain began and how it has progressed.
• Which activities trigger or worsen the pain.
• Whether you’ve experienced any injuries or repetitive strain related to sports, work, or daily activities.
• If you have any history of similar conditions or other joint-related issues.

Physical Examination

During the physical exam, the doctor will assess the affected elbow and forearm by:

• Palpating the Elbow: Applying pressure to the lateral epicondyle (the bony bump on the outer elbow) to check for tenderness or pain.
• Testing Grip Strength: Evaluating your ability to grip objects, which can help determine if the tendons are weakened.
• Range of Motion Assessment: Moving the wrist and elbow through various motions to see which movements cause discomfort.
• Specific Provocative Tests:
  • Cozen’s Test: You’ll be asked to make a fist and extend your wrist while the doctor applies resistance. Pain during this movement often indicates tennis elbow.
  • Mill’s Test: The doctor will stretch the wrist and fingers while extending the elbow to check for pain around the lateral epicondyle.

Imaging Tests (If Needed)

While tennis elbow is usually diagnosed through a physical exam, imaging tests may be used to rule out other conditions or assess the severity of tendon damage:

• X-rays: Although they don’t show soft tissue damage, X-rays can help rule out conditions like inflammatory arthritis or bone fractures that may be causing elbow pain.
• MRI (Magnetic Resonance Imaging): An MRI provides detailed images of soft tissues, helping identify the extent of tendon tears or degeneration.
• Ultrasound: A dynamic imaging option that allows doctors to see the tendons in motion, helping detect inflammation or small tears.

Differential Diagnosis: Ruling Out Other Conditions

Several conditions can mimic the symptoms of tennis elbow, so it’s important to rule out:

• Golfer’s Elbow (Medial Epicondylitis): A similar condition affecting the inner side of the elbow.
• Elbow Bursitis: Inflammation of the fluid-filled sacs around the elbow.
• Nerve Compression (Radial Tunnel Syndrome): Compression of nerves near the elbow that can cause similar pain.
• Arthritis: Joint inflammation that may lead to elbow discomfort and stiffness.

A thorough diagnosis allows your healthcare provider to tailor a treatment plan that addresses the root cause of your symptoms and supports a full recovery.

Read more-Everything You Should Know About Septic Arthritis

Treatment Options for Tennis Elbow

The treatment for tennis elbow focuses on relieving pain, reducing inflammation, and restoring strength and mobility in the affected arm. In most cases, non-surgical treatments are highly effective, though surgery may be considered if symptoms persist after several months of conservative care.

Non-Surgical Treatments

Rest and Activity Modification:

• Rest is often the first step in treatment. Avoid activities that trigger pain, especially repetitive wrist and arm motions.
• Modifying daily activities or work habits can help prevent further strain on the tendons.

Medications:

• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen or naproxen help reduce pain and inflammation.
• Topical NSAIDs: Creams or gels applied directly to the elbow can offer localized relief.

Bracing and Supports:

• A tennis elbow brace or forearm strap can help reduce strain on the affected tendon by redistributing pressure.
• Wrist splints may also be used to limit wrist movement and give tendons time to heal.

Physical Therapy:

• Physical therapy is one of the most effective treatments for tennis elbow. A therapist will guide you through:
  • Stretching exercises to improve flexibility.
  • Strengthening exercises targeting forearm muscles, helping to support the elbow joint.
  • Manual therapy techniques like massage to reduce tension in the muscles.
  • Eccentric exercises (where muscles lengthen under tension) have been shown to be especially effective in promoting tendon healing.

Injections:

• Corticosteroid Injections: These may provide temporary pain relief and reduce inflammation but are generally reserved for short-term use due to potential side effects.
• Platelet-Rich Plasma (PRP) Injections: PRP therapy uses your own blood’s platelets to promote healing and reduce inflammation in the affected tendon.

Surgical Treatments

Surgery is considered when non-surgical treatments fail to relieve symptoms after 6-12 months. The goal of surgery is to remove the damaged tendon tissue and stimulate healing.

• Open Surgery:
  • Involves making an incision over the elbow to remove the damaged tendon tissue and reattach healthy tendons to the bone.
  • This is the traditional approach with a high success rate.
• Arthroscopic Surgery:
  • A minimally invasive procedure using small incisions and a camera to remove damaged tissue.
  • Typically results in less post-operative pain and a quicker recovery.

Post-Surgery Recovery:

• Physical therapy is essential after surgery to restore strength and mobility.
• Most people can return to normal activities within 4-6 months, though recovery time varies based on the extent of the procedure.

Alternative and Complementary Therapies

• Shockwave Therapy: Uses sound waves to stimulate tendon healing and reduce pain.
• Acupuncture: Some patients find relief through acupuncture, which may help reduce pain and inflammation.
• Ultrasound Therapy: Increases blood flow to the affected area, promoting healing.

In most cases, a combination of rest, physical therapy, and activity modification leads to significant improvement without the need for surgery.

Read more- Rheumatoid Arthritis: A Guide to Early Detection and Treatment

Tennis Elbow Exercises and Therapy

Physical therapy is essential for recovering from tennis elbow, helping to reduce pain, improve flexibility, and strengthen the forearm muscles to prevent future injuries. Here are a combination of stretching and strengthening exercises that can accelerate healing and restore function:

1. Stretching and Flexibility Exercises

• Wrist Extensor Stretch: Extend your affected arm in front with the palm facing down. Gently pull your fingers downward using your opposite hand until you feel a stretch in the forearm. Hold for 15-30 seconds and repeat 3 times.
• Wrist Flexor Stretch: With your arm extended and palm facing up, gently pull the fingers back toward your body to stretch the forearm muscles. Hold for 15-30 seconds and repeat 3 times.

These stretches help improve flexibility and reduce tension in the forearm muscles and tendons.

2. Strengthening Exercises

Eccentric Wrist Extensions: Hold a light dumbbell with your palm facing down. Slowly lower the wrist, then use your opposite hand to return it to the starting position. Perform 3 sets of 10-15 repetitions.

• Wrist Curls: With your forearm resting on a table and palm facing up, curl your wrist upward using a light weight, then slowly lower it. Do 3 sets of 10-15 repetitions.
• Supination and Pronation: Hold a light dumbbell vertically (like a hammer) and rotate your wrist so the palm faces up, then back down. Perform 3 sets of 10 repetitions.

These exercises help rebuild forearm strength, supporting the elbow and reducing tendon strain.

3. Grip Strengthening and Functional Exercises

• Towel Twist: Hold a rolled-up towel and twist it as if wringing out water, first in one direction, then the other. Repeat 10 times each way to strengthen grip and forearm muscles.
• Hand Squeeze: Use a soft ball or therapy putty, squeezing and holding for 5 seconds before releasing. Perform 3 sets of 10-15 repetitions.

Grip exercises enhance hand strength and support forearm stability.

4. Therapy Techniques

• Massage Therapy: Techniques like cross-friction massage can help break down scar tissue and promote tendon healing.
• Soft Tissue Therapy: Myofascial release and gentle stretching improve flexibility and reduce muscle tightness around the elbow.

5. Exercise Tips

• Start slowly and gradually increase intensity.
• Perform exercises 3-5 times per week for optimal recovery.
• Stop any movement that causes sharp pain—mild discomfort is normal, but sharp pain may indicate overuse.

Incorporating these exercises into your recovery routine can significantly improve strength, flexibility, and function, helping you manage and prevent tennis elbow more effectively.

Read more-Frozen Shoulder: Causes, Symptoms, and Treatments

Prevention Tips for Tennis Elbow

While tennis elbow often results from repetitive strain and overuse, adopting simple preventive strategies can reduce the risk of developing the condition or prevent recurrence after recovery.

Use Proper Technique

Whether playing sports or performing repetitive tasks at work, using correct form is essential. In tennis, for example, ensuring proper grip size and using the right stroke technique can minimize stress on the forearm muscles. Similarly, in work settings, using ergonomic tools and maintaining good posture can help reduce strain.

Strengthen Forearm Muscles

Building strength in the forearm muscles supports the tendons and reduces the load placed on them during repetitive tasks. Regularly perform wrist curls, extensions, and grip-strengthening exercises to improve endurance and stability.

Stretch Before and After Activity

Stretching the forearm muscles before engaging in repetitive tasks or sports helps warm up the tendons and muscles, reducing the risk of injury. Post-activity stretching can also help maintain flexibility and prevent stiffness.

Take Regular Breaks

Prolonged repetitive movements increase the risk of strain. Taking short breaks during work or sports allows muscles and tendons to rest, preventing overuse. Simple actions like shaking out the hands or stretching the wrists can help during breaks.

Use Supportive Equipment

Wearing a tennis elbow brace or forearm strap during high-risk activities can help distribute pressure away from the injured tendon, reducing strain. Using wrist supports or ergonomic tools at work can also help prevent overuse injuries.

Avoid Repetitive Overuse

Gradually increase activity intensity, especially when starting a new sport or hobby. Overdoing repetitive motions too quickly can strain the tendons. Listen to your body and stop if you experience discomfort.

Warm-Up and Cool Down

Incorporate a warm-up routine before physical activity to prepare the muscles and tendons for movement. Cooling down afterward helps relax the muscles and maintain flexibility, reducing post-activity stiffness.

By incorporating these preventive strategies into your daily routine, you can significantly lower your risk of developing tennis elbow and protect your arms from repetitive strain injuries.

Tennis Elbow Recovery: What to Expect

Recovering from tennis elbow varies from person to person, depending on the severity of the condition, the chosen treatment approach, and how closely rehabilitation guidelines are followed. Understanding what to expect during recovery can help set realistic goals and ensure a smoother healing process.

1. Typical Recovery Timelines

• Mild to Moderate Cases: With rest, activity modification, and physical therapy, most mild cases improve within 6 to 8 weeks. Consistent stretching and strengthening exercises during this period help speed up recovery.
• Chronic or Severe Cases: More persistent cases, especially those left untreated for months, may require 3 to 6 months of rehabilitation. Non-surgical treatments like physical therapy combined with braces or injections are often used.
• Post-Surgical Recovery: If surgery is necessary, the recovery timeline extends. Patients typically need 4 to 6 months to regain full strength and range of motion. Physical therapy plays a key role post-surgery to restore functionality and prevent recurrence.

2. Factors That Influence Recovery Time

• Severity of the Condition: Chronic cases with significant tendon damage take longer to heal.
• Adherence to Treatment: Following exercise regimens, using braces, and modifying activities directly impact recovery speed.
• Type of Activity: Individuals returning to repetitive or strenuous tasks may need additional time for strengthening and conditioning.
• Age and Overall Health: Younger, active individuals often heal faster, while older adults or those with underlying conditions may experience a longer recovery.

3. Tips for a Successful Recovery

• Gradually Resume Activities: Ease back into work or sports, starting with light tasks and increasing intensity gradually.
• Continue Strengthening Exercises: Even after pain subsides, maintaining forearm strength and flexibility is crucial to prevent recurrence.
• Monitor for Flare-Ups: If pain returns during recovery, reduce activity levels and consult a healthcare provider if symptoms persist.
• Use Supportive Gear: Consider wearing a brace during activities that strain the forearm, even after recovery, especially in high-risk sports or occupations.

Recovery from tennis elbow requires patience and consistency. While many people experience significant improvements within weeks, full recovery, especially in chronic cases, may take several months. Adhering to treatment recommendations and avoiding re-injury are key to long-term success.

Conclusion

Tennis elbow is a common overuse injury that can impact daily activities, work, and sports. While it often starts as mild discomfort, ignoring the symptoms can lead to chronic pain and limited arm function. The good news is that with early diagnosis, proper treatment, and dedicated rehabilitation, most people recover fully without the need for surgery.

If you’re struggling with persistent elbow pain or suspect you might have tennis elbow, Graphic Era Hospital offers expert care to help you regain strength and mobility. Our team of specialists provides comprehensive diagnosis, personalized treatment plans, and advanced therapies to support your full recovery. Schedule a consultation today and take the first step toward pain-free life.