Lateral Epicondylitis (Tennis Elbow)

What tennis elbow is

The muscles that lift the wrist and fingers attach to the outer elbow through a shared tendon, mainly the extensor carpi radialis brevis. Repeated gripping and wrist extension overload this tendon. Rather than ongoing inflammation, as the old term "-itis" implies, the tendon shows degeneration and failed healing, which is why doctors increasingly call it lateral elbow tendinopathy.

Symptoms

• pain and tenderness on the bony bump on the outside of the elbow
• pain spreading into the top of the forearm
• pain when gripping, lifting (especially a kettle or bag with the palm down), turning a key or doorknob, using a mouse, or shaking hands
• weak grip and dropping objects
• stiffness in the morning
• usually the dominant arm

Causes and risk factors

• repetitive gripping and wrist movements: carpentry, plumbing, painting, gardening, butchery, typing and mouse use
• racket sports, especially with poor backhand technique or the wrong grip size
• sudden increases in activity
• age 35 to 55
• smoking and obesity

Tests for tennis elbow

A doctor or physical therapist will press on the outer elbow and test whether these movements reproduce your pain:

• lifting the wrist or middle finger against resistance
• gripping strength (pain-free grip test)
• stretching the wrist down with the elbow straight

They will also check the neck, the elbow joint and the radial nerve. Imaging is not usually needed. Ultrasound or MRI may be used if the diagnosis is unclear or symptoms persist despite treatment.

Conditions that can mimic tennis elbow

For other causes of elbow pain, see elbow pain.

Treatment

Load management

Reduce, but do not stop, the activities that provoke pain. Adjust technique and equipment:

• lift with the palm facing up
• use tools with thicker, padded handles
• improve keyboard and mouse setup, keeping wrists neutral
• in tennis, check grip size, string tension and backhand technique

Exercises

Progressive loading exercises are the most effective long-term treatment. A typical program, usually guided by a physical therapist:

1. Isometric wrist extension: hold the wrist steady against resistance for 30 to 45 seconds, repeated several times, to reduce pain.
2. Eccentric wrist extension: slowly lower a light weight with the palm down, using the other hand to lift it back up. 3 sets of 15, once or twice a day.
3. Gradual progression in weight and speed, plus grip strengthening and forearm stretches.

Mild pain during exercise (up to about 3 or 4 out of 10) is acceptable if it settles by the next day. Improvement usually takes 6 to 12 weeks.

Pain relief

• ice packs for 15 minutes after activity
• topical NSAID gels (such as diclofenac) at the label dose
• acetaminophen (paracetamol) or oral NSAIDs for short periods; avoid NSAIDs if you have stomach ulcers or kidney disease

Braces

A counterforce strap worn just below the elbow, or a wrist splint that holds the wrist slightly extended, can reduce tendon load during activity.

Injections and other options

• Steroid injections relieve pain for a few weeks but are linked to slower recovery and more recurrence at 6 to 12 months, so they are used sparingly.
• Platelet-rich plasma (PRP) injections have mixed evidence.
• Shockwave therapy may help some persistent cases.

Surgery

Surgery to remove damaged tendon tissue is considered only after 6 to 12 months of failed non-surgical treatment. Most people do not need it.

Recovery and outlook

Tennis elbow is self-limiting in most people, usually resolving within 6 to 12 months, and around 9 in 10 people recover within a year. Recurrence is common if the triggering activity is resumed too quickly, so build back gradually.

Frequently asked questions

What are the symptoms of tennis elbow?

The main symptom is pain on the outside of the elbow that can spread down the forearm. It is worse with gripping, lifting with the palm down, turning doorknobs and shaking hands. Grip may feel weak.

What is the fastest way to heal tennis elbow?

There is no quick fix. Reducing aggravating activities, starting progressive wrist strengthening exercises early, using a forearm strap and topical anti-inflammatory gel give the best results. Steroid injections relieve pain short term but can slow long-term recovery.

How long does tennis elbow last?

Most cases last 6 to 12 months, even with treatment, though many people improve sooner. About 9 in 10 people recover within a year. Persistent cases may need specialist treatment.

Should I rest tennis elbow completely?

No. Avoid the specific movements that cause pain, but keep the arm moving and start gentle loading exercises. Complete rest can weaken the tendon and slow recovery.