Tennis Elbow: Symptoms, Causes, and Treatment

Tennis elbow (lateral epicondylitis) is swelling, inflammation, and subsequent tearing of the tendons in your forearm.

These tissues, which attach muscle to bone, can become overtaxed with repetitive use, causing an aching or burning pain that gets worse when you grip or lift something.

Tennis elbow can take up to two years to fully heal. Treatment of tennis elbow is conservative and usually involves rest, wearing a brace, and taking an anti-inflammatory medication.

Sometimes, tennis elbow can be confused with other conditions, so it's best to have the condition diagnosed by a healthcare provider. 

Symptoms of Tennis Elbow

The most common symptoms of tennis elbow are:

• An aching or burning pain over the outside of the elbow that is worsened by gripping or lifting
• Pain starts at the elbow but then may spread to the forearm
• Weak grip strength

The pain associated with tennis elbow usually has a gradual onset, but it may also come on suddenly. Pain can be highly variable too, ranging from very mild to severe and debilitating.

What Causes Tennis Elbow?

Despite its name, tennis elbow does not solely occur in tennis players.

The primary cause of tennis elbow is a problem with the tendon (called the extensor carpi radialis brevis muscle tendon) that attaches to the outside part of the elbow bone called the lateral epicondyle, thus giving tennis elbow the medical name 'lateral epicondylitis.'

This tendon is the attachment site of the muscle that functions to cock the wrist back (called wrist extension).

It's important to note that tennis elbow is not simply a tendon inflammation. Rather, as a result of repetitive use, experts believe that incompletely healed microscopic tears develop within the tendon.

This leads to a degenerative ("wear and tear") process and subsequent pain and tenderness felt at the outside of the elbow.

While tennis elbow may occur on its own, there are two groups of people that are especially vulnerable to developing this condition:

• Sports participants: Athletes, especially racquet sport players, are prone to developing tennis elbow. About a third of amateur tennis players experience tennis elbow at some point in their careers. In addition to racquet sports, tennis elbow is seen in golfers, fencers, and other sports participants.
• Manual laborers: People who work with their hands are at greater risk of developing tennis elbow. Jobs that may lead to tennis elbow include plumbers, painters, gardeners, and carpenters.

Besides activities that require repetitive gripping and grasping, trauma (in the form of a direct hit to the elbow which leads to tendon swelling) can also cause tennis elbow; although, this is a less common culprit.

Diagnosis

The diagnosis of tennis elbow is made through a medical history and physical examination. Additional tests may be ordered to rule out other conditions that cause elbow pain.

Besides tennis elbow, there are several other causes of pain over the outside of the elbow including instability of the joint, elbow arthritis, radial tunnel syndrome, and cervical radiculopathy.

These conditions are generally considered if the symptoms are not typical for tennis elbow, or if a person with presumed tennis elbow does not respond to treatment.

Medical History and Physical Examination

In addition to inquiring about the characteristics of your elbow pain (e.g., location and severity), your healthcare provider will ask you about any potential risk factors, like whether you have participated in a certain job or sports-related activities or experienced a recent elbow injury or trauma.

Your healthcare provider will also ask you about your medical history, like whether you have a history of rheumatoid arthritis or elbow nerve entrapment.

During the physical exam, your healthcare provider will press on your elbow at various sites to evaluate for tenderness. With tennis elbow, there is usually tenderness about one centimeter from the lateral epicondyle itself.

Your healthcare provider will also move (flex and extend) your wrist while your arm and elbow are held out to see if this increases or reproduces your pain.

Other Tests

Various tests may be used to diagnose some of the above conditions. For example, while an X-ray should be normal with a tennis elbow, it may reveal changes consistent with elbow arthritis.

Likewise, a magnetic resonance imaging (MRI) scan is also often normal, although in some individuals the affected tendon may show some abnormal changes. An MRI can also be useful for diagnosing radial tunnel syndrome

Other tests, such as nerve conduction study and electromyography (EMG), are sometimes conducted to rule out nerve compression. Blood tests may be utilized to help diagnose inflammatory conditions like rheumatoid arthritis.

Tennis Elbow Treatment

Recovering from tennis elbow can be a long process. Some people don't achieve full recovery for one or two years after their symptoms begin. Others may recover completely in around six months.

The good news is that tennis elbow usually gets better on its own. Treatment of tennis elbow entails simple, non-surgical steps. With sufficient time, most individuals respond well.

There are a few steps you can take to help your tennis elbow heal faster. Make sure to get plenty of rest and wear a tennis elbow brace and a wrist brace to protect your tendons from strain. You can also work with a physical therapist to learn strengthening and stretching exercises that will help speed up your recovery.

Non-Surgical Therapies

For most people, one or more of the following treatments are effective for treating tennis elbow:

• Rest and activity modification: Stopping or significantly limiting activities that trigger and/or aggravate the condition (oftentimes for several weeks) is a key first step to healing.
• Medication: Under the guidance of your healthcare provider, taking a nonsteroidal anti-inflammatory drug (NSAID), can ease inflammation and pain.
  
• Physical therapy: Performing exercises that stretch and strengthen your forearm muscles, as well as various techniques like ice massage, heat, or ultrasound, can help improve muscle function and speed up healing.
• Steroid injection: In certain cases, your healthcare provider may opt to inject cortisone (a strong anti-inflammatory medication) into the area near your lateral epicondyle.

Braces and Splints

Wearing a tennis elbow brace (a band worn over the back of your forearm muscle just below your elbow) can ease the stress on the tendon and muscle.

A wrist brace can also be helpful. This type of brace restricts the use of your wrist, which will prevent excess strain on the tendons in your elbow.

Surgery

A small percentage of patients diagnosed with tennis elbow will ultimately require surgical treatment.

Generally speaking, patients may consider surgery if more conservative treatments are not effective after a period of six to 12 months.

A Word From Verywell

While "tennis elbow" or lateral epicondylitis is a painful and frustrating condition, be at ease knowing that you are not alone.

This condition is common, and with proper time and treatment, the vast majority of people experience tendon healing and relief.