Tennis Elbow: Causes, Symptoms, And Treatments

symptoms of tennis elbow

Don’t let that name fool you! Tennis elbow is not just something you can be afflicted by if you play tennis or other racquet sports regularly. This overuse injury, also known as lateral epicondylitis, can also happen when you are involved in other activities or sports. Any kind of repetitive motion that involves the elbow can lead to tennis elbow. These can include driving for long hours, plumbing, painting and even cooking or woodwork. Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. Once these forearm muscles and tendons become damaged due to overuse from repetitive motions, pain and tenderness sets in.1

According to a study in the UK, the annual incidence of tennis elbow is around 4 to 7 cases per 1000 patients, mostly observed in patients aged 35 to 55 years. The condition affects 1 to 3 percent of the population and is usually self-limiting with moderate to severe pain. Tennis elbow can last anywhere between 6 and 24 months, with 20 percent of cases lasting over a year.2


What Are The Causes Of Tennis Elbow?

According to the North American Journal of Sports Physical Therapy, tennis elbow is a relatively common condition that can affect persons who perform repetitive upper body activities such as carpenters, musicians, chefs, and butchers.3

  • The risk factors for tennis elbow are repetitive manual tasks, handling of loads greater than 20 kg or operating heavy tools and machinery that weigh more than 1 kg.
  • The risk is increased by a working posture of arms raised in front of the body, coupled with repetitive forearm twisting or rotating.
  • High gripping force is also likely to increase your chances of tennis elbow.
  • Surprisingly, the condition is also associated with computer use of more than 20 hours per week which means a major chunk of the working population is afflicted by it.
  • The risk increases in line with years of use. Yes, even a desk job like computer programming with too much typing and mouse use can be the cause of tennis elbow.4

Tennis elbow is most commonly seen in people between the ages of 30 and 50, although anyone can get it if they have the risk factors. In racquet sports, improper stroke technique and improper equipment may be risk factors and lead to tennis elbow. However, the condition can also occur without any recognized repetitive or overuse injury–this is called insidious tennis elbow.5


Studies have shown that tennis elbow is often caused due to damage to a specific forearm muscle, usually in your dominant arm. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. When this muscle is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle.6

What Are The Symptoms Of Tennis Elbow?

  • One of the most significant symptoms of tennis elbow is pain and tenderness on the outside of the elbow.
  • You may also have pain in the forearms and the wrists, all of which usually escalates with activity.
  • Another one of the tell-tale signs of tennis elbow is weak grip strength–this can be tested by standing behind a chair and trying to lift it by putting hands on top of the back of the chair with palms down. If you have tennis elbow, you will experience pain on the outside of the elbow while doing so.7

Do these tennis elbow signs ring a bell? Just experiencing the signs and symptoms of tennis elbow shouldn’t have you self-diagnosing and treating. Some other conditions may mimic tennis elbow, such as

  • Ligament sprain or insufficiency
  • Radial nerve entrapment
  • Elbow joint disease
  • Entrapment of the interosseous nerve
  • Partial or complete tear of the tendon
  • Cervical dysfunction
  • or nerve root compression. That is why you need a doctor who will probably ask you to undergo an X-ray. In some cases, the doctor might even take the help of an MRI or an ultrasound.8

Some Ways You Can Treat Tennis Elbow

So if you’re experiencing any or all of the symptoms of tennis elbow, what do you do? What are the tennis elbow treatment options? Despite a large number of studies investigating a range of options, there is no particularly favored evidence-based treatment for the overuse injury that gives anything beyond short-term pain relief. However, there are still a lot of modalities, from invasive to non-invasive in order to ease the pain and continue participating in daily activities.9

According to the American Academy of Orthopaedic Surgeons, 80 to 95 percent of patients have success with one or the other or a combination of non-surgical tennis elbow treatment.

  • The first choice is usually to give the elbow a rest for a couple of weeks. If your injury is indeed sports-related, the doctor might encourage you to check the equipment you use to play. As a preventive measure, you may want to wear elbow supports, wristbands or a brace while playing.10
  • It is advisable to lift objects close to the body, with your elbow bent and palms facing upwards.
  • Avoid repetitive gripping and twisting activities and take regular breaks from all activities involving the upper limb.
  • Despite modification of aggravating activities and taking rest, if tennis elbow symptoms still persist beyond 12 weeks, it might be wise to try physiotherapy along with home exercise for relief.
  • Laser therapy could also be considered. Studies have illustrated that low-level laser therapy (LLLT) may be beneficial in the short-term, particularly in lessening pain and increasing grip strength. These tennis elbow treatment options are often combined with NSAIDs (Non-steroidal anti-inflammatory medicines) to manage pain and reduce swelling.11
  • Among non-invasive methods, Therapeutic Eccentric Exercise (TEE) has also become popular and studies reveal that it is an inexpensive home-based treatment. An extension of physical therapy, patients can do these exercises themselves after learning the techniques from web videos.12
  • Electrical stimulation, extracorporeal shockwave therapy, friction massage and ultrasound therapy are some other solutions for tennis elbow symptoms.13
  • If the pain is simply too much to handle, corticosteroid injections offer short-term relief. However, do not make a habit of it as studies link it to long-term relapses and the likelihood of adverse effects.14
  • Autologous blood injections are yet another way to get rid of tennis elbow pain – almost completely. Studies have revealed them to be effective when no other non-surgical method works. It causes no pain even during strenuous activity. In this treatment, the doctor draws blood from any other part of your body and injects it at the site of the pain.15
  • When all else fails, open or arthroscopic surgery is the last resort for those who suffer from the condition for more than a year.16