Elbow Conditions

Tennis Elbow (Lateral Epicondylitis)

Tennis Elbow: Causes, Symptoms and Treatment Options

Tennis elbow, medically known as lateral epicondylitis, is a common condition that causes pain on the outer side of the elbow. It occurs when the tendons that attach the forearm muscles to the elbow become irritated or degenerate due to repetitive use or strain.

Despite its name, tennis elbow does not only affect tennis players. It commonly develops in people who perform repetitive gripping, lifting, or wrist extension activities, including manual workers, tradespeople, office workers, and recreational athletes. Tennis elbow can interfere with everyday activities such as lifting objects, gripping tools, turning door handles, shaking hands, or using a computer mouse.

What Causes Tennis Elbow?

Tennis elbow develops when the tendon attaching the forearm muscles to the outer elbow becomes overloaded. The most commonly affected tendon is the extensor carpi radialis brevis (ECRB) tendon, which helps stabilise and extend the wrist during hand and arm movement. Repetitive stress can lead to small, microscopic tears within the tendon. Over time, the tendon may become weakened and degenerative rather than inflamed, which is why tennis elbow is sometimes described as a tendon degeneration condition rather than a purely inflammatory problem.

Common contributing factors include:

Repetitive gripping or lifting activities
Overuse during sport, particularly racquet sports
Manual labour or repetitive occupational tasks
Sudden increase in training intensity or workload
Poor technique or equipment setup in sport
Age-related tendon degeneration, most commonly between ages 35 and 55

In many cases, tennis elbow develops gradually without a single identifiable injury.

Symptoms of Tennis Elbow

Symptoms of tennis elbow typically develop gradually and may worsen over time.

Common symptoms include:

Pain or tenderness on the outer side of the elbow
Pain that may radiate down the forearm
Weak grip strength
Pain when lifting objects, shaking hands, or turning door handles
Discomfort when extending the wrist or fingers
Increased pain during repetitive arm use

Pain is often worse when gripping objects with the arm extended or when performing lifting tasks with the palm facing down.

How Tennis Elbow Is Diagnosed

Diagnosis is usually based on a clinical assessment. This involves a detailed history and physical examination to identify typical symptom patterns and areas of tenderness. During examination, specific movements that stress the affected tendon are used to help confirm the diagnosis. Imaging may sometimes be recommended, particularly when symptoms persist or alternative diagnoses are being considered. Imaging options may include:

These investigations help guide treatment decisions and exclude other causes of elbow pain.

Ultrasound to assess tendon structure

MRI to evaluate tendon degeneration or partial tearing

X-rays if arthritis or other bone-related conditions are suspected

Non-Surgical Treatment Options for Tennis Elbow

Most cases of tennis elbow improve with non-operative treatment. The goal is to reduce tendon stress, promote healing, and restore strength and function.

Non-surgical treatment options may include:

Activity modification to reduce repetitive strain
Physiotherapy focusing on tendon loading programs and forearm strengthening
Ergonomic assessment for workplace or sporting activities
Anti-inflammatory medications where appropriate
Bracing or counterforce straps to reduce tendon load
Corticosteroid injections in selected cases for short-term symptom relief
Biologic injections such as platelet-rich plasma (PRP) in selected patients

Tendon healing can take time, and symptoms often improve gradually over several months.

When Tennis Elbow Surgery May Be Considered

Surgical treatment may be considered when symptoms persist despite appropriate non-operative management and significantly affect daily activities or work capacity.

Tennis Elbow Surgery (Lateral Epicondylitis Surgery)

Surgery aims to remove damaged tendon tissue and promote tendon healing. The procedure may involve:

Removal of degenerated tendon tissue
Repair or reattachment of healthy tendon fibres
Release of tight tendon structures contributing to overload

Depending on the severity and pattern of tendon injury, surgery may be performed using minimally invasive or open techniques.

Dr Richard Dallalana will discuss the most appropriate surgical approach based on your symptoms, imaging findings, and functional goals.

Recovery and Rehabilitation After Tennis Elbow Treatment

Recovery depends on symptom severity and whether surgery is required.

Rehabilitation typically includes:

Gradual return to arm movement and daily activities
Progressive strengthening of the forearm and wrist muscles
Technique and ergonomic modifications
Staged return to sport or manual work

Recovery following non-surgical treatment may take several months. Recovery after surgery typically involves structured rehabilitation and gradual return to full activity over several months.

Choosing the Right Treatment for Tennis Elbow

The most appropriate treatment approach depends on several factors, including:

Dr Richard Dallalana provides comprehensive assessment of tennis elbow to determine the most suitable treatment strategy for each patient.

When to Seek Specialist Assessment for Tennis Elbow

You may benefit from specialist review if elbow pain:

Persists despite rest or physiotherapy
Interferes with work, sport, or daily activities
Causes significant weakness or reduced grip strength
Continues to worsen over time
Limits your ability to perform repetitive arm tasks

Early assessment can help confirm the diagnosis and guide appropriate management.

If you’re experiencing ongoing pain, stiffness, or reduced movement that is affecting your daily activities or quality of life, a thorough orthopaedic assessment can help determine the cause and guide the most appropriate treatment options for your situation.