Tennis Elbow (Lateral Epicondylitis)
Sources consulted
This article is original patient-education content.
- WHO—Health topics A–Z(2024)
- NHS—Health A to Z(2024)
- CDC—Health topics(2024)
Based on international clinical guidelines
Overview
Tennis elbow, also called lateral epicondylitis, is a painful condition where the tendons that attach to the bony bump on the outside of your elbow become irritated or damaged. It is not an infection or arthritis, but a type of repetitive strain injury. Despite the name, you don't have to play tennis to get it – any activity that involves repeated gripping or wrist movements can cause it.
Key facts
- Tennis elbow is caused by overuse of the forearm muscles and tendons, not by a sudden injury.
- It is most common in people between the ages of 30 and 50.
- Most people recover within 6 to 12 months with rest and simple self-care measures.
Yes, tennis elbow is quite common. It affects about 1 to 3 in every 100 people each year in the UK.
Tennis elbow affects people of all ages, but it is most common in adults between 30 and 50 years old. It is equally common in men and women. People whose jobs or hobbies involve repetitive gripping, twisting, or lifting – such as carpenters, plumbers, chefs, and tennis players – are more likely to develop it.
Symptoms
- Sudden, severe elbow pain after a fall or injury.
- Elbow that looks deformed or is bent at an unusual angle.
- Numbness, tingling, or loss of feeling in your hand or fingers.
- Signs of infection: red, hot, or swollen elbow with a fever.
- ⚠Pain that gets worse despite rest and over-the-counter pain relief.
- ⚠Swelling or redness around the elbow that spreads.
- ⚠Inability to move your elbow or use your hand normally.
Common symptoms
- Pain and tenderness on the outside of the elbow, which may spread down the forearm.
- Pain that worsens when you grip, twist, or lift objects, even light ones like a cup of coffee.
- Stiffness in the elbow, especially in the morning.
- Weak grip strength, making it hard to hold things firmly.
Symptoms in children
- Pain on the outside of the elbow after activities like playing sports or video games.
- Reluctance to use the arm for gripping or throwing.
- Mild swelling or tenderness that comes and goes.
Symptoms in older adults
- Pain that is less sharp but more constant, often interfering with daily tasks like gardening or cooking.
- Increased stiffness and reduced range of motion in the elbow.
- Weakness in the forearm that makes it hard to open jars or turn doorknobs.
Causes
Main causes
- Repeated overuse of the forearm muscles and tendons from activities like gripping, twisting, or lifting.
- Sudden increase in activity level, such as starting a new sport or taking on more manual work.
- Poor technique or equipment in sports, such as a tennis racket that is too heavy or a grip that is too tight.
Risk factors
- Jobs that involve repetitive hand and wrist motions, such as plumbing, painting, carpentry, or assembly line work.
- Hobbies or sports that require frequent gripping or throwing, like tennis, badminton, squash, or weightlifting.
- Age between 30 and 50 years old.
- Smoking, which can reduce blood flow and slow tendon healing.
- Previous elbow or shoulder injury on the same side.
When to see a doctor
See a doctor urgently if:
- If you have sudden, severe elbow pain after an injury.
- If your elbow looks deformed or you can't move it after a fall.
- If you have signs of infection (redness, heat, swelling, or fever).
Book a routine appointment if:
- If elbow pain lasts more than a few weeks despite rest and self-care.
- If pain is affecting your sleep or daily activities.
- If you have weakness in your grip that is getting worse.
Diagnosis
Your doctor will diagnose tennis elbow by talking to you about your symptoms and activities, and by examining your elbow. They will press on the tender spot and ask you to move your wrist and hand in certain ways to see if it reproduces the pain. In most cases, no special tests are needed.
Tests that may be done
- Physical examination: your doctor will check for tenderness on the outer elbow and may test your grip strength.
- Imaging tests (rarely needed): an X-ray may be done to rule out other problems like arthritis, or an ultrasound or MRI if the diagnosis is unclear or if symptoms are severe.
What to expect at your appointment
During your visit, the doctor will ask about your job, hobbies, and when the pain started. They will gently move your elbow and wrist to see which movements cause pain. The examination is usually straightforward and not painful. You will likely leave with advice on self-care and possibly a referral to a physiotherapist.
Treatment
Treatment for tennis elbow focuses on reducing pain and promoting healing. Most people get better with simple self-care and time. A stepped approach is used, starting with rest and activity changes, then adding treatments like physiotherapy or braces if needed. Surgery is rarely required and considered only when other treatments fail after 6 to 12 months.
Self-care at home
- Rest the affected arm by avoiding activities that cause pain, such as gripping or lifting.
- Apply ice packs to the sore area for 15-20 minutes several times a day to reduce pain and swelling.
- Use a counterforce brace or strap around the upper forearm, which can take pressure off the tendon.
- Practice gentle stretching exercises for the wrist and forearm, as advised by a physiotherapist.
- Take over-the-counter pain relief, such as paracetamol or ibuprofen, following the package instructions (but talk to your doctor first if you have other health conditions).
Medical treatments
If self-care isn't enough, your doctor may recommend physiotherapy, which includes specific exercises to strengthen the forearm muscles and improve flexibility. Some people benefit from using a wrist splint to rest the tendon. In more persistent cases, a healthcare provider might suggest treatments like corticosteroid injections or platelet-rich plasma injections to reduce inflammation and promote healing. However, injections are not always effective and their use is debated. Always discuss risks and benefits with your doctor.
When is surgery considered?
Surgery is considered only if symptoms have not improved after 6 to 12 months of non-surgical treatment. The procedure involves removing damaged tissue from the tendon. Most people who have surgery eventually recover, but it can take several months of rehabilitation afterward.
Living with this condition
Living with tennis elbow means making small adjustments to avoid pain. For example, use both hands to lift objects, avoid gripping tools too tightly, and take regular breaks during repetitive tasks. Using ergonomic tools with larger grips can also help. Many people find that using a counterforce brace during activities reduces discomfort.
Lifestyle tips
- Switch to lighter or ergonomic versions of tools and equipment, like a larger-grip pen or a racket with a softer string.
- Take frequent breaks during activities that involve gripping or lifting.
- Warm up your forearm muscles with gentle stretches before sports or manual work.
- Avoid lifting heavy objects with the palm facing down – use two hands or a different grip.
Diet and exercise
Eating a balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, whole grains, and healthy fats, may support healing. Include foods containing vitamin C (for collagen) and omega-3 fatty acids. Gentle exercises like wrist stretches and forearm strengthening are helpful, but avoid anything that causes pain. A physiotherapist can design a safe exercise programme for you.
Mental health and emotional wellbeing
Chronic pain from tennis elbow can be frustrating and may affect your mood, sleep, and ability to do things you enjoy. It's normal to feel discouraged. Talking to friends, family, or a counsellor can help. Remember that most people recover fully, and focusing on small improvements each week can boost your spirits.
Prevention
Yes, tennis elbow can often be prevented. Key steps include: using proper technique in sports and work, warming up before activity, using the right equipment (e.g., a tennis racket with a comfortable grip), and avoiding overuse by gradually increasing the intensity of activities. Strengthening your forearm muscles with regular exercises can also help protect your tendons.
Complications
If left untreated
- Chronic pain that lasts more than a year and may become constant.
- Weakness in the forearm and hand that makes it hard to perform daily tasks.
- Reduced range of motion in the elbow.
Long-term outlook
The outlook for tennis elbow is very good. Most people feel better within 6 to 12 months with simple treatments like rest, ice, and gentle exercises. Even if it takes longer, the condition is not dangerous and rarely leads to permanent problems. With the right care, nearly everyone returns to their normal activities. Stay patient and follow your healthcare provider's advice.
Find support
International organisations
Local organisations
- NHS Inform (Scotland) ↗ · Scotland
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Always verify with your doctor
Health guidelines vary by country and region. The information in this article is based on international clinical guidelines but may not reflect the specific guidelines, medications, or practices in your country. Always discuss your health concerns with your own doctor or healthcare provider, and refer to your local national health guidelines where available.
Important notice This information is for educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your specific situation. If you are experiencing a medical emergency, call your local emergency services immediately.