Tennis Elbow (Lateral Epicondylitis)

What is tennis elbow?

Tennis elbow is an injury that causes pain and inflammation in your elbow. It’s usually a repetitive strain injury.

Repetitive strain injuries happen when you use a part of your body to repeatedly do the same kind of motion so often that it damages your tissue.

Tennis elbow gets its name from being a common sports injury for people who play tennis or other racket sports. It happens when you overuse the tendon that connects your forearm muscles to your elbow (your extensor muscle tendon).

The medical term for tennis elbow is lateral epicondylitis. Epicondylitis is inflammation in the extensor muscle tendon. Lateral epicondylitis means the inflammation is on the lateral side — the outside edge when you hold your arms at your sides with your palms facing forward, the same direction as your eyes.

Any motion that makes you grip or twist and swing your forearm often can cause tennis elbow. Visit a healthcare provider if you have an elbow injury or feel pain that doesn’t get better on its own in a week. Seeing a provider as soon as the pain starts can increase your treatment options (and how well they work).

How common is tennis elbow?

Tennis elbow is one of the most common causes of elbow pain. Experts estimate that around 3% of all people in the U.S. experience tennis elbow each year.

Even though it’s named for tennis, experts estimate that more than 90% of people who have tennis elbow don’t develop it from playing tennis or other sports.

What are tennis elbow symptoms?

The most common tennis elbow symptoms include:

• Elbow pain (especially on the outside of your elbow — the side furthest away from the center of your body when your arms are at your sides with your palms facing forward).
• Stiffness.
• Swelling.
• A weakened grip (especially when you’re trying to hold something like a racket, pen or shake someone’s hand).

How do you know if you have tennis elbow?

You can’t know for sure you have tennis elbow without visiting a healthcare provider for a diagnosis. Lots of people with tennis elbow feel a specific kind of pain in their elbow and arm. The pain usually feels:

• Sharp or burning.
• Worse when you twist or bend your arm (like turning a doorknob, opening a jar or swinging your arm).
• Like it spreads (radiates) from your elbow down to your forearm and into your wrist (especially at night).

Does tennis elbow affect one or both arms?

Most people develop tennis elbow in their dominant arm (the side you naturally use for most activities). You’re most likely to have tennis elbow in whichever arm you use the most for a repetitive activity — the arm you hold a racket or tools with.

It’s less common, but it’s possible to develop tennis elbow in both arms at the same time.

What causes tennis elbow?

Any motion or activity that you frequently repeat can trigger tennis elbow. Extra stress from repetitive movements builds up over time. Eventually, that added use and stress on your extensor muscle tendon causes tiny tears (microtraumas). Those microtraumas cause symptoms you can feel and notice.

It’s less common, but a sudden arm or elbow injury can also cause tennis elbow.

What are the risk factors?

Anyone can develop tennis elbow, but some people are more likely to, including people who:

• Lift more than 45 pounds (22 kilograms) regularly.
• Are older than 40.
• Smoke.
• Have obesity (a body mass index, or BMI, of 30 or higher).

Athletes who play sports that put stress on their arms or elbows, including:

• Tennis (and other racket sports like squash, pickleball or racquetball).
• Baseball.
• Softball.
• Bowling.
• Golf.
• Weight lifting.

People whose jobs or hobbies put lots of stress on their elbows, including:

• Painters.
• Musicians.
• Chefs or cooks.
• Carpenters.
• Plumbers.
• Cleaners.
• Gardeners.
• Manicurists.

What are tennis elbow complications?

Tennis elbow usually doesn’t cause serious complications. If you keep using your injured elbow before your tendon heals, you can increase your chances of rupturing (tearing) it.

How do providers diagnose tennis elbow?

A healthcare provider will diagnose tennis elbow with a physical exam and some tests. They’ll examine your injured elbow and ask about your symptoms. Tell your provider when you first noticed pain, stiffness or other symptoms and if any activities make them worse (or better).

Tennis elbow tests

Your provider may use some of the following tests to check for damage inside your arm and take pictures of your elbow:

• Elbow X-ray.
• Ultrasound.
• Magnetic resonance imaging (MRI).
• Electromyography (EMG).

What are tennis elbow treatments?

Your provider will suggest treatments to help your tendon heal. The RICE method is usually the best way to fix tennis elbow:

• Rest: Take a break from the activity that caused tennis elbow. Try to avoid using your elbow while it heals.
• Ice: Apply a cold compress or ice pack to your elbow for 15 to 20 minutes at a time, a few times a day. Wrap ice packs in a towel or thin cloth so they don’t touch your skin directly.
• Compression: Wrap a compression bandage around your elbow. Your provider can show you how to safely apply the compression bandage.
• Elevation: Keep your elbow above the level of your heart as often as you can.

Other nonsurgical (conservative) tennis elbow treatments include:

• Over-the-counter (OTC) pain relievers: Over-the-counter NSAIDs or acetaminophen reduce swelling and relieve pain. Talk to your provider before taking these medications for more than 10 days in a row.
• Physical therapy: A physical therapist will give you stretches and exercises to strengthen the muscles around your elbow and increase your flexibility.
• Wearing a brace: Wrist and elbow braces will allow your tendon to rest so it can heal. Your provider will tell you which kind of brace you’ll need and how often to wear it.
• Platelet-rich plasma: Your provider will take a sample of your blood and then process it to concentrate platelets (proteins that encourage healing). Then, they’ll inject that blood sample into your elbow.
• Corticosteroids: Corticosteroids are prescription anti-inflammatory medications. Your provider may inject cortisone shots into your injured elbow. Corticosteroids aren’t as common as other treatments because they may not relieve pain, especially if you’ve felt pain for more than six weeks.
• Tenotomy: Your provider will poke a needle through your skin and into your injured tendon using an ultrasound to guide them. They’ll break down and remove damaged tissue to encourage your body’s natural healing process.
• Shockwave therapy: Your provider will direct a specific pressure frequency where your tendon is injured. The shockwaves encourage your body to speed up the healing.

Tennis elbow surgery

Most people don’t need surgery to repair tennis elbow. Your provider may suggest surgery if you’re still having severe symptoms after several months of conservative treatments.

Your surgeon will remove damaged tissue and repair your tendon. Most tennis elbow surgeries are outpatient procedures, which means you can go home the same day.

Your surgeon will tell you which type of surgery you’ll need, what you can expect and how long it’ll take to recover.

How soon after treatment will I feel better?

You should start feeling better as soon as you start resting your elbow and avoiding the activity that caused tennis elbow. It can take several months for your elbow to heal. It depends on what caused the injury, how severely it damaged your tendon and how long you’ve had pain. Ask your provider what to expect.

How can I prevent tennis elbow?

The best way to prevent tennis elbow is to avoid overusing your arm and elbow.

During sports or other physical activities:

• Wear the right protective equipment for all work, sports or hobbies.
• Don’t “play through pain” during or after physical activity.
• Give your body time to rest and recover after intense activity.
• Stretch and warm up before playing sports or working out.
• Cool down and stretch after physical activity.
• Do sport-specific exercises or exercises that keep your body healthy for your sports, hobbies or job.

What can I expect if I have tennis elbow?

You should expect to take a break from the physical activities that caused tennis elbow. You may need to stop doing some activities completely, or do them with modifications (like wearing a brace while you work or taking breaks more often).

People almost always make a full recovery from tennis elbow. You should be able to resume all your usual activities once your tendon heals, even if you need surgery.

How long tennis elbow lasts

Tennis elbow can last anywhere from a few months to more than a year. It usually takes around six months to recover, but some people need longer (up to 18 months).

How long it’ll take you to recover depends on a few factors:

• What caused the tennis elbow.
• How damaged your tendon is.
• Which treatments you need.

When should I see my healthcare provider?

Visit a healthcare provider if you think your elbow is injured or you notice any of the following signs of tennis elbow:

• It’s hard to move your elbow or arm.
• Your elbow is swollen or discolored.
• You’re in severe pain that makes it hard to do your usual activities (including sleeping).
• You have pain that lasts more than a week.

Which questions should I ask my provider?

• What caused the tennis elbow?
• Will I need any tests?
• Which treatments will I need?
• Will I need surgery?
• How should I modify my daily routine?

How do you know if you have tennis elbow or tendinitis?

Tendinitis is inflammation or irritation in a tendon that makes it swell. That means you technically always have tendinitis if you have tennis elbow. But it’s not an extra condition or injury, just another way your provider might classify what’s going on inside your elbow.

Some people with tennis elbow might actually have tendinosis. No matter what’s causing pain in your elbow, visit a provider as soon as possible.

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

Tennis and elbow and golfer’s elbow are similar conditions. They’re both repetitive strain injuries caused by overusing your arm and elbow.

Tennis elbow affects the extensor muscle tendon on the outer (lateral) part of your elbow. Golfer’s elbow affects the tendon on the inner (medial) part of your elbow. The medical term for golfer’s elbow is medial epicondylitis.