Tennis Elbow (Lateral Epicondylitis)
Tennis elbow is a condition of wear in the tendons of the wrist extensor muscles where they attach to the bony prominence on the outer side of the elbow. Despite the name, most patients do not play tennis; the condition is more closely related to repetitive gripping and wrist strain.
Not Inflammation, but Wear
Although the “-itis” ending suggests inflammation, studies have shown that what is actually found is not classical inflammation but structural breakdown in the tendon tissue. This distinction directly affects treatment: the aim is not to suppress inflammation but to increase the tendon’s load-bearing capacity gradually.
For that reason loaded exercise is central to the current approach; complete rest and prolonged immobility are not recommended.
Symptoms
- Sharp tenderness on the outer side of the elbow that can be pointed to with a finger
- Pain increased by gripping: carrying a bag, turning a door handle, opening a bottle, shaking hands
- Pain becoming marked when lifting the wrist against resistance
- Pain that can radiate down the forearm
- Reduced grip strength; dropping things
Symptoms generally begin insidiously and patients often cannot recall a particular event. In others they begin after an unaccustomed strain such as painting, pruning or moving house.
Diagnosis
- History: occupational and sporting hand use, duration of symptoms, movements that trigger pain.
- Examination: point tenderness over the outer bony prominence, resisted wrist and middle finger extension tests, examination of the neck and shoulder.
- X-ray: generally normal; may be requested to exclude other causes such as osteoarthritis and calcification.
- Ultrasound / MRI: not essential for diagnosis; requested where symptoms have been prolonged or another problem is suspected.
In the differential diagnosis, pain referred from the neck, nerve compression on the outer side of the elbow and problems within the joint are considered. If the picture is atypical or the expected response to treatment is not obtained, these possibilities are reviewed.
Treatment
The core approach: manage load, strengthen the tendon
The backbone of treatment is a graded loaded exercise programme. Results come over weeks to months; maintaining the programme regularly is decisive.
- Temporarily reducing (not stopping) the gripping movements that trigger pain
- Eccentric and progressive strengthening of the wrist extensor muscles
- Assessment of the shoulder girdle and trunk muscles — load distribution is often overlooked
- Reviewing grip technique, tool and racquet handle size, and working arrangements
- Pain management; a forearm brace may give temporary relief in some patients
Corticosteroid injection into the tendon is approached with caution. It may reduce pain in the short term; however, repeated applications may adversely affect the tendon tissue in terms of long-term outcome. The decision is made by your physician according to the clinical picture.
Surgical treatment
Surgery is considered in patients whose symptoms persist and restrict daily life or work despite a prolonged, regularly applied programme. It is based on removing the degenerate tendon tissue and fixing it to healthy tissue; it can be performed with open or arthroscopic methods.
The decision to operate is not rushed; a significant proportion of patients reach an adequate level with the non-surgical programme. No guarantee of a specific result or timeframe is given for any treatment.
What Helps in Daily Life?
- Carry a heavy bag with the arm close to the body rather than gripping with the palm
- Review the thickness of tool and racquet handles; a thin handle increases grip load
- Break up repetitive gripping tasks and rest the wrist in between
- Continue the exercise programme for a period after the pain has settled
- Do not neglect shoulder and trunk strength
When Should You Seek Assessment?
- If pain on the outer side of the elbow has lasted weeks
- If your grip strength has decreased or you drop things
- If pain interrupts your sleep at night
- If numbness or tingling accompanies it (nerve involvement is assessed)
- If there has been no improvement for months despite an exercise programme
When to Seek Medical Help Without Delay
- Redness, warmth, swelling and fever at the elbow
- Severe pain and inability to move the elbow after an injury
- Progressive loss of strength in the forearm, numbness or wrist drop
These findings require urgent assessment. Outside office hours, go to the nearest emergency department.
Frequently Asked Questions
I do not play tennis — why do I have tennis elbow?
The condition is not limited to tennis; any work or activity involving repetitive gripping and wrist strain can cause it. Most patients do not play tennis. The name has stuck because of the group in which it was first described.
Will it settle if I rest?
Complete rest is not recommended; immobility further reduces the tendon’s load-bearing capacity. What is recommended is temporarily reducing the movements that trigger pain and starting a graded strengthening programme.
Should I have a steroid injection?
It may reduce pain in the short term; however, repeated injections into the tendon may adversely affect tissue quality and the long-term outcome is debated. The decision is made by your physician according to the clinical picture.
Does an elbow brace help?
A forearm brace can give temporary relief in some patients by distributing the load during gripping. It does not replace the exercise programme and is not presented as a solution on its own.
How long does it take to settle?
The timeframe varies markedly from person to person and is related to how long symptoms have been present. For that reason no fixed period is given; maintaining the programme regularly is the most important factor affecting the outcome.
Can the same happen on the inner side of the elbow?
Yes; a similar condition occurs on the inner side of the elbow and is commonly known as golfer’s elbow. The treatment logic is largely similar: load management and graded strengthening.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of upper limb surgery and elbow arthroscopy and related areas. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Hand and Wrist Surgery
- Elbow Arthroscopy
- Carpal Tunnel Syndrome
- Trigger Finger (Stenosing Tenosynovitis)
- Shoulder and Upper Extremity
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any treatment or surgical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.