Tennis Elbow (Lateral Epicondylitis)

What is tennis elbow?

Tennis elbow is an overuse injury that occurs when tendons (tissues that attach muscles to bones) become overloaded, leading to inflammation, degeneration and potential tearing. It commonly affects tennis players who grip their racquets too tightly. But anyone can develop this painful condition, medically known as lateral epicondylitis.

How common is tennis elbow?

Between 1% to 3% of Americans get tennis elbow. It’s most common in people ages 30 to 50 and affects all genders.

Who might get tennis elbow?

Anyone who regularly performs repetitive activities that vigorously use the forearms, wrists or hands can get tennis elbow. Tennis elbow can affect recreational and professional:

• Baseball and softball players.
• Bowlers.
• Fencers.
• Golfers.
• Tennis, squash, pickleball and racquetball players.

People who work in certain professions are also more prone to tennis elbow:

• Assembly line workers and auto mechanics.
• Butchers and chefs.
• Carpenters, cleaners, painters and plumbers.
• Dentists.
• Gardeners and landscapers.
• Manicurists.
• Musicians.

Does tennis elbow affect one arm or both arms?

Tennis elbow typically affects your dominant side. But depending on the type of repetitive activities, you may get tennis elbow in both arms.

What’s the difference between tennis elbow and golfer’s elbow?

Tennis elbow is a condition of the lateral (outside) epicondyle tendon, or outer part of the elbow. Golfer’s elbow is a condition of the medial (inside) epicondyle tendon, or inner part of the elbow. The medical term for golfer’s elbow is medial epicondylitis.

People with golfer’s elbow have inner elbow pain that radiates down the arm. They can also have finger numbness and tingling. Golfers can get tennis elbow, just as tennis players may get golfer’s elbow.

What causes tennis elbow?

Repetitive arm movements can cause your forearm muscles to get fatigued. A single tendon attaches this muscle to the bony bump on the outside of your elbow (lateral epicondyle). As your muscle gets tired, the tendon takes more of the load. This overloading can cause inflammation and pain, known as tendinitis. Over time, this overloading can cause a degenerative condition known as tendinosis. Together tendinitis and tendinosis can then lead to tendon tearing.

Sometimes, a sudden arm or elbow injury causes tennis elbow. Rarely, people develop the condition for no known reason (idiopathic tennis elbow).

What are the symptoms of tennis elbow?

Tennis elbow is usually the result of overuse. Symptoms tend to come on slowly. Pain may get worse over weeks and months. Signs of tennis elbow include:

• Burning or pain on your outer elbow that may travel to your wrist (these sensations may get worse at night).
• Pain when twisting or bending your arm (for instance, to turn a doorknob or open a jar).
• Stiffness or pain when extending your arm.
• Swollen elbow joint that’s tender to touch.
• Weakened grip when you try to hold items like a racquet, wrench, pen or someone’s hand.

How is tennis elbow diagnosed?

Your healthcare provider will perform a physical exam to check for elbow joint pain, swelling and stiffness. Your provider may also ask about activities that can cause pain. To make a diagnosis, you may have one or more of these tests:

• X-rays torule out conditions like arthritis or a broken bone.
• Imaging tests, including ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT) scans, assess tendon and muscle damage.
• Electromyography (EMG) checks for compressed nerves by measuring muscle and nerve electrical activity.

What are the complications of tennis elbow?

Pain from tennis elbow can make it hard to work or do physical activities. The condition can also affect your grip, which can make it difficult to grasp items. In general, tennis elbow doesn’t cause serious, long-term problems.

How is tennis elbow managed or treated?

Tennis elbow may get better on its own with little, if any, treatment. However, that recovery may take up to 18 months. Proven nonsurgical techniques exist that can accelerate your recovery. Nonsurgical and minimally invasive treatments for tennis elbow include:

• Rest: You may need to stop or decrease activities for several weeks to give tendons time to heal.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, including ibuprofen (Advil®) and naproxen (Aleve®), may ease pain and inflammation.
• Braces: Your provider may recommend wearing a removable support brace called a counterforce brace. This tool takes tension off of tendons and muscles.
• Physical therapy: Physical therapy exercises can strengthen forearm muscles and your grip. Massage, ultrasound or other muscle-stimulating techniques may help to reduce pain and improve function.
• Steroid injections: Injectable corticosteroids temporarily relieve joint pain and inflammation. These injections must be placed in the correct area, which is why many providers will perform these injections under ultrasound guidance.
• Platelet-rich plasma (PRP) therapy: Platelets are tiny cell fragments in your blood that aid healing. During a (PRP) therapy injection, your provider removes a small amount of blood and separates platelets from other blood cells. Then they inject the concentrated platelets into the injured area under ultrasound guidance.
• Extracorporeal shock wave therapy: Sound waves can break up scar tissue. Afterward, blood flow to the damaged area improves.
• Minimally invasive tenotomy: Your provider may perform a minimally invasive procedure to remove degenerative tendon tissue from inside your tendon. This procedure (called TenJet) uses a needle device with high pressured saline to create suction and hydro-resect the degenerative tendon tissue. This may be an alternative to a larger surgical procedure.

If symptoms don’t improve after six to 12 months of nonsurgical therapies, your provider may recommend surgery, like an arthroscopic or open debridement of the tendon or a tendon repair. Surgery typically involves removing the injured tendon and muscle. Your provider replaces the damaged tissue with healthy tendon and muscle from a different part of your body. Recovery can take four to six months. Once you’ve had tennis elbow, you may need to wear a brace to keep symptoms from returning.

How can I prevent tennis elbow?

These steps can help you avoid tennis elbow:

• Don't push through pain. Pain is your body’s way of talking to you, and you need to listen. Pushing through pain can lead to damage to your tendon and potential tearing.
• Check equipment for proper fit. For example, stiff or loose-strung racquets may reduce stress on your forearm.
• Lift weights to strengthen forearms and wrist muscles.
• Stretch wrists and arms before starting work or an activity.
• Wear an elbow brace to keep symptoms from worsening.

What is the prognosis (outlook) for people who have tennis elbow?

Approximately 95% of people with tennis elbow get better with nonsurgical treatments. Afterward, they can resume activities. It may take six to 18 months for symptoms to go away.

A small number of people need surgery. Between 80% to 90% of people who get tennis elbow surgery see their symptoms improve within one year.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Difficulty moving your arm, extending it or holding items.
• Red, swollen joints, or a bump or bulge on your elbow.
• Severe pain that interferes with sleep or daily activities.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• Why did I get tennis elbow?
• What is the best treatment for tennis elbow?
• What changes should I make to manage symptoms?
• What changes should I make to prevent the problem from happening again?
• Should I watch for signs of complications?

A note from Cleveland Clinic

Anyone who does activities or a job that requires repetitive arm motions (extending and bending) can get tennis elbow. See your healthcare provider if bending and straightening your arm causes pain or your outer elbow is tender to touch. Your provider can offer suggestions to reduce pain and inflammation. Rarely, people with tennis elbow need surgery. With proper treatment, you can safely return to the work or activities you enjoy pain-free.