Tennis Elbow

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is tennis elbow?

Do people who play tennis develop this painful tendinitis of the elbow? Sure. But so do many other people who have never swung a racquet in their life.

Tennis elbow is inflammation of the tendons (tendinitis or tendonitis) of the elbow caused by overuse. Properly called lateral epicondylitis, tennis elbow most often affects the extensor tendons that attach your forearm muscles to the upper arm bone (humerus). This group of tendons passes over a bony prominence on the humerus called the lateral epicondyle, which is on the outer, or lateral side of the elbow. Interestingly, tennis elbow is usually caused by repeatedly bending the wrist, which engages the forearm muscles that pull the extensor tendons over the epicondyle.

Tennis elbow occurs more often in middle-aged people than others, and several occupations see higher rates of epicondylitis. The painful condition affects both men and women. Fortunately, conservative measures usually relieve the pain, though difficult cases—when nothing seems to help—may require surgery. Tennis elbow can cause permanent grip weakness if not treated.

What are the symptoms of tennis elbow?

Pain is the most common symptom of lateral epicondylitis. The initial pain may be mild, but it gets worse over time. Other tennis elbow symptoms may include a decline in grip strength and pain that worsens when engaging in an activity that involves using the forearm muscles.

Because the pain of tennis elbow rarely clears up on its own, you should see a doctor if you experience elbow pain or grip weakness that lasts for more than a couple of weeks. Your doctor can provide an accurate diagnosis and offer conservative treatments that usually can improve the pain quickly.

What causes tennis elbow?

Tennis elbow is caused by irritation of the tendons that cross over the lateral epicondyle of the elbow. This irritation usually occurs from overuse of the extensor carpi radialis brevis (ECRB) muscle of the forearm. This is the muscle that enables you to flex and extend your wrist. The ECRB attaches to an extensor tendon at the elbow joint. The ERCB extends across your wrist and attaches via another tendon to a bone in your hand (the third metacarpal).

When the ECRB is flexed repeatedly, such as when hitting tennis balls, it pulls the extensor tendon across the lateral epicondyle with each wrist flexion. This excessive rubbing causes microscopic tears in the tendon. Many activities can cause this damage to the extensor tendons, including:

  • Athletic activities that use the forearm muscles, such as tennis and other racquet sports like pickle ball

  • Improper technique during sports activities involving the arms

  • Poor ergonomics that affect the alignment of the wrist when engaging in activities like keyboarding

  • Repetitive use of the forearm or repeated bending of the wrist, which causes the extensor tendons to rub frequently against the epicondyles

Sometimes it’s not possible to identify a cause for tennis elbow. Doctors call this insidious lateral epicondylitis.

What are the risk factors for tennis elbow?

Certain occupations can increase your risk for developing lateral epicondylitis. Common risk factors for this condition include:

  • Age between 30 and 50

  • Athletic activities that use the wrist and hands

  • Occupations that require extensive use of the forearm muscles including painters, auto mechanics, plumbers and carpenters

Reducing your risk of tennis elbow

You may be able to lower your risk of developing tennis elbow by:

  • Avoiding repetitive forearm actions

  • Correcting improper racquet technique

  • Observing good ergonomics and taking frequent breaks

  • Strengthening your forearm muscle

  • Using properly sized and weighted racquets and other hand-held athletic gear

If you are at risk of developing lateral epicondylitis and experience any of its symptoms, you should see a doctor to obtain a diagnosis. Early treatment can spare you the pain of tennis elbow and help you avoid losing grip strength.

How is tennis elbow treated?

Fortunately, up to 95% of all cases of lateral epicondylitis respond to conservative treatment. If you’re looking for a tennis elbow cure, the following strategies may be part of your treatment plan:

  • Avoiding the repetitive motion activities that caused the tennis elbow in the first place

  • Anti-inflammatory medicine such as ibuprofen according to your doctor’s directions

  • Forearm brace, which provides counter pressure and takes stress off the extensor tendons

  • Physical therapy, which includes a variety of techniques to heal and strengthen the area

  • Resting the arm for a few days to a few weeks

  • Steroid injections to the reduce inflammation in the elbow

If your symptoms persist after six months to a year of conservative treatment, your doctor might suggest surgery to relieve the pain. Depending on the extent of your tendon injuries, your doctor may be able to repair tissue tears or reattach affected muscles to the arm bones. Tennis elbow surgery, including elbow tenotomy, usually is performed in the traditional, open manner, though some orthopedic surgeons perform arthroscopic elbow surgery

What are the potential complications of tennis elbow?

Left untreated, tennis elbow could cause increasing pain and permanent loss of grip strength. Fortunately, most people naturally avoid the activities that cause their elbow pain, thereby resting the joint and allowing some of the tissue damage to heal without serious complications. Physical therapy is also very effective.

When surgery is required to address tennis elbow, the risks can include:

  • Damage to nerves and blood vessels

  • Infection

  • Lengthy rehabilitation period

  • Permanent loss of arm strength and joint flexibility

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 22
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  1. Tennis Elbow (Lateral Epicondylitis). American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00068
  2. Tennis elbow. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987
  3. Tendinitis. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/tendinitis.html