Tennis elbow (lateral epicondylitis) is pain on the outer side of the elbow caused by overuse strain of the tendon where the muscles that lift the wrist backwards attach to the bony bump at the outside of the elbow; it is common even in people who do not play tennis [1][2]. Most people recover with non-surgical measures such as rest, activity changes, exercise and strapping, although symptoms can sometimes last over a year; surgery is considered for the small number whose symptoms do not settle after 6 to 12 months of appropriate treatment [1][2].
What is tennis elbow?
The forearm muscles that lift the wrist and fingers backwards attach by a tendon to the bony bump on the outer side of the elbow (the lateral epicondyle). The tendon of one of these muscles (extensor carpi radialis brevis) is the structure most often affected [2].
Repeated strain causes tiny tears where the tendon joins the bone, leading to pain and tenderness. Despite the name, most people who get it do not play tennis [1][2].
Which symptoms are typical?
Pain usually starts slowly and builds over weeks and months, from mild discomfort to constant pain that disturbs sleep [1][2]:
- Pain or a burning feeling on the outer side of the elbow
- Pain that increases when lifting, gripping or turning the wrist
- Tenderness when the outer side of the elbow is touched
- Pain spreading into the forearm and weaker grip
- Difficulty fully straightening the arm
Who gets it, and why?
The cause is work that needs repeated gripping and turning of the wrist: long periods of using a computer mouse, sewing, using a screwdriver or brush, and racket sports are examples [1][2]. People in hand-intensive jobs such as painters, plumbers and carpenters are affected more often, and it is commonest in the 30s and 50s [1][2].
How is it diagnosed?
Diagnosis is mostly from your story and examination: the doctor checks for tenderness on the outer side of the elbow and for pain when the wrist is lifted against resistance [2].
Imaging is not always needed. An X-ray may be requested to exclude other causes such as arthritis, an MRI to see how much the tendon is damaged and a nerve conduction test (EMG) to exclude nerve entrapment [2].
What to try first at home and in physiotherapy
The first step is to avoid for a while the movements that provoke the pain. Paracetamol or an anti-inflammatory gel, hot or cold packs for up to 20 minutes several times a day and a forearm strap from the pharmacy can help [1][2].
If home measures have not helped after 6 weeks, physiotherapy is advised: massage and stretching and strengthening exercises for the wrist and forearm can be used [1]. According to a Cochrane review, manual therapy and exercise may slightly reduce pain and disability at the end of treatment, but the evidence that this lasts is weak [4].
Steroid injection
A steroid injection can reduce pain quickly in the short term. In a randomised trial, however, patients given a steroid injection had worse one-year outcomes than those given a placebo injection and their symptoms came back more often [3]. The pros and cons should therefore be discussed in detail with the doctor.
PRP and injections of your own blood
Platelet-rich plasma (PRP) and injections made from a person's own blood are also used [2]. A Cochrane review reported no meaningful benefit over placebo for pain and function with these injections [5]. Most people get a result with non-surgical treatment [2].
Surgery and recovery
If symptoms have not settled after 6 to 12 months of appropriate non-surgical treatment, surgery can be considered [1][2]. In the operation the damaged tendon tissue is cleared and healthy tissue is reattached to the bone, using either an open or an arthroscopic (keyhole) approach [2].
After surgery the arm is protected in a splint for a short time, then movement exercises begin; strengthening is added at about two months and return to sport is usually possible 4 to 6 months after the operation [2].
Without surgery too, tennis elbow often settles with a few weeks of rest, but in some people symptoms last more than a year, so patience and keeping up the treatment programme matter [1].
When not to wait
Tennis elbow is not an emergency; see a doctor if pain lasts more than 2 weeks despite home measures [1]. Go to the emergency department straight away if [6]:
- There is severe arm pain with difficulty moving it
- A tearing sound was heard at the time of injury or the arm changed shape
- There is tingling or numbness in the arm
- Swelling of the arm comes with a high temperature or shivering
- Arm pain starts suddenly together with pressure, heaviness or tightness in the chest: this may be a sign of a heart attack, so call emergency services at once (112 in Northern Cyprus and Türkiye)
Frequently asked questions
- How long does tennis elbow take to go?
- In most people it settles with a few weeks of rest and activity changes; in some, symptoms last more than a year [1].
- Should I have a steroid injection?
- It can bring relief in the short term, but one-year results were worse than with placebo and symptoms returned more often. The decision should be made after discussing the pros and cons with your doctor [3].
- Does PRP work?
- A Cochrane review reported that PRP and own-blood injections gave no meaningful benefit over placebo for pain and function [5].
At our clinic we first confirm by examination that the pain comes from the tendon on the outer side of the elbow, request imaging if it is needed, and then plan treatment together with you, talking openly about the pros and cons of injections and surgery.
Sources
- Tennis elbow. NHS (nhs.uk), 2024. nhs.uk
- Tennis Elbow (Lateral Epicondylitis). American Academy of Orthopaedic Surgeons (OrthoInfo). orthoinfo.org
- Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial (Coombes BK, et al.). JAMA, 2013. pubmed.ncbi.nlm.nih.gov
- Manual therapy and exercise for lateral elbow pain (Wallis JA, et al.). Cochrane Database of Systematic Reviews, 2024. pubmed.ncbi.nlm.nih.gov
- Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain (Karjalainen TV, et al.). Cochrane Database of Systematic Reviews, 2021. pubmed.ncbi.nlm.nih.gov
- Elbow and arm pain. NHS (nhs.uk), 2024. nhs.uk
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
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