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What Is the Symptoms of Tennis Elbow? How Is Tennis Elbow Treated?

What Is Tennis Elbow? What Causes Tennis Elbow? Tennis elbow (lateral epicondylitis) is a painful condition. It often occurs as a result of strenuous overuse of the muscles and tendons of the forearm and around the elbow joint. As its name suggests, tennis elbow can sometimes be caused by playing tennis, but many other common activities can cause tennis elbow. It is also known as “shooter’s elbow” and “archer’s elbow”.

The main symptom of tennis elbow is pain and inflammation on the outside of the elbow. Pain can also spread into the forearm and wrist.

According to Medilexicon’s medical dictionary:

Tennis elbow is a “chronic inflammation at the origin of the extensor muscles of the forearm from the lateral epicondyle of the humerus, as a result of unusual or repetitive strain (not necessarily from playing tennis).”

Symptoms can also sometimes occur on the inner side of the elbow. This is often referred to as golfer’s elbow.

The elbow joint

It is surrounded by muscles that move the elbow, wrist and fingers. The tendons in the elbow join the bones and muscles together. They control the muscles of the forearm that are located around the lateral epicondyle.

Tennis elbow occurs when one or more of the tendons in the elbow become inflamed. The pain occurs at the spot where the tendons of the forearm muscle attach to the bone.

When this area becomes inflamed, certain movements that use the forearm can be painful (twisting movements may be particularly painful).

Tennis elbow usually occurs in adults. The condition occurs mostly in those who are between 30 and 50 years of age.

In most cases of tennis elbow the symptoms will clear up regardless of whether the patient receives treatment or not. Anti-inflammatory painkillers can often help to reduce mild pain and inflammation. If pain is severe or prolonged, a cortisone (steroid) injection may be recommended. Occasionally, surgery may be used to treat very severe and persistent cases.

Symptoms of tennis elbow

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Symptoms of tennis elbow may include:

A painful grip during certain activities, such as shaking hands or turning a doorknob, pouring a pitcher of liquid, lifting something with the palm down.

Difficulty holding certain objects, such as a coffee cup. Pain that is caused by lifting, or bending the arm.

Pain when writing, or when gripping small objects, such as a pen.

Weakness of the forearm.

Pain that gets worse over weeks or months.

Pain that radiates from the outside of the elbow into the forearm and wrist.

Pain when extending the wrist.

Difficulty extending forearm fully.

The pain of tennis elbow is similar to golfer’s elbow. But golfer’s elbow occurs on the inside of the elbow.

Self-care steps such as rest, ice and use of over-the-counter pain relievers should ease elbow pain and tenderness. Seek medical care if:

Elbow is hot and inflamed, and there is a fever

Elbow cannot bend

Elbow looks deformed

Suspicion there could be a broken a bone


The pain that is caused by tennis elbow usually lasts for between 6 to12 weeks. However, some people have pain for as little as three weeks, while others may experience discomfort in their elbow joint for several years.

The pain can range from mild discomfort when using the elbow, to severe pain that can be felt even when the elbow is still, or even when sleeping. There can be stiffness in the arm. This can gets progressively worse as the damage to the tendon increases.

As the body tries to compensate for the weakness in the elbow, pain or stiffness may be experienced in other parts of the affected arm, the shoulder, or neck.

 Causes of tennis elbow

This inflammation can occur as a result of small tears in the tendon. They become inflamed. Excessive, or repeated, use of the muscles that straighten the wrist can injure the tendons in the arm and elbow. If these injuries are not allowed to heal fully, they can tear again, leading to the formation of rough tissue.

A protein called collagen leaks out from around the injured areas, causing inflammation. The inflamed tendon can cut off blood flow and pinch the radial nerve. It is one of the major nerves that control the muscles in the arm and hand. This causes pain when the arm is used.

Usually, tennis elbow occurs after doing an activity where the forearm muscles are heavily used, without having used them much before. However, even people who use their forearm muscles frequently can still develop the condition.

Activities that can cause tennis elbow

The tendons in the elbow can be injured by overuse of the forearm muscles in repeated actions such as:

gardening and other common arm motions, including painting, raking and weaving

manual work that involves repetitive turning, or lifting of the wrist, such as plumbing or bricklaying

racquet sports

sports that involve lots of throwing



using scissors

The risk of getting tennis elbow is higher if racquet sports, such as tennis, or squash, are played regularly. The risk also increases when returning to these sports after not playing for a long time. Repeated use of the backhand stroke with poor technique can cause the condition.

Risk factors of tennis elbow

Tennis elbow is most common in adults ages 30 to 50. However the condition can affect anyone who repetitively stresses the wrists.

Anyone who uses repetitive movements for at least two hours a day is at greater risk. People who smoke also have a higher risk of developing tennis elbow.

 Tennis elbow diagnosis

A simple at-home test can be performed to help determine whether you have tennis elbow:

Stand behind a chair and place hands on top of the chair back with palms down. Try to lift the chair up. If this causes pain on the outside of your elbow, it is most likely tennis elbow.

During the medical assessment, the affected arm will be examined and symptoms will be reviewed. The pain and stiffness will be evaluated by applying pressure to the affected area, moving the elbow, wrist and fingers in various ways.


Tennis elbow itself cannot be seen on an X-ray. However, an X-ray may be recommended in order to rule out other conditions, such as arthritis, a fracture, or an injury inside the elbow joint.

MRI or ultrasound scan

These may be recommended to make sure that the pain is not being caused by pressure on a nerve. In the case of severe tennis elbow that has failed to heal, a magnetic resonance imaging (MRI) scan, or an ultrasound scan may be needed. This will produce a more detailed image than an X-ray, as it includes the soft tissues, muscles, and tendons inside the arm.

Complications of tennis elbow

Left untreated, tennis elbow can result in chronic pain. The pain can get worse, especially when lifting or gripping objects. Also, using the affected arm too strenuously before the elbow has healed can worsen the problem.

Treatment for tennis elbow

Tendons are slow to heal and therefore the symptoms can last for a number of weeks, or months. In some cases, they can persist for up to a year. However, tennis elbow is a condition that will eventually clear up by itself. Tennis elbow often gets better on its own in six months to two years.


Avoid any activities that put more stress on the tendons.

If the pain is affecting function, initial treatment of tennis elbow usually involves self-care steps including rest, icing the area and use of acetaminophen (Tylenol, others). Over-the-counter anti-inflammatory medications can also be used, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others). Children under 16 years of age should not take aspirin.

However, these medications are not recommended for long-term use because they can cause serious gastrointestinal problems.

As well as tablets, anti-inflammatory painkillers are also available in the form of creams and gels which can be rubbed into the affected area. There is indication that these may be more effective at providing pain relief from tennis elbow compared with tablets.

Analyzing technique

Experts can evaluate tennis technique or job tasks to determine the best steps to reduce stress on the injured tissue. This may mean switching to two-handed backhand in tennis, or taking ergonomic steps at work.


A doctor or a physical therapist may suggest exercises to gradually stretch and strengthen the muscles, especially of the forearm.


A doctor may suggest wearing straps or braces to reduce stress on the injured tissue.

Vibration therapy

It can be used for localized pain relief and inflammation with vibration therapy devices available for home use.

Cortisone steroid injections

If tennis elbow symptoms are particularly severe and persistent, and the condition is making movement difficult, a steroid injection may be recommended. Cortisone is the steroid that is usually used because it helps to reduce inflammation.

Cortisone will be injected into the tender spot in the elbow using a fine needle. It is usually combined with an anesthetic so that it is not painful. Most people who have a cortisone injection find that their pain improves significantly, or disappears completely.

However, in some cases, the pain relief is only temporary. In such cases, two, or three, steroid injections may be needed over the course of a number of weeks.

Injectable corticosteroids rarely cause serious side effects.

The use of topical corticosteroids for pain relief may be suggested. These corticosteroids are absorbed through the skin during treatments called phonophoresis or iontophoresis.


If other approaches have not relieved pain, surgery may be recommended in cases of severe, persistent tennis elbow. The operation involves removing the damaged part of the tendon in order to relieve the symptoms of pain. Only about one in 10 people with tennis elbow need surgery.


Other treatments for tennis elbow are under investigation. Some treatments being studied include acupuncture, botulinum toxin and topical nitric oxide.

Other treatments with limited scientific support include:

Blood injection (possibly augmented by plateletpheresis)

Extra-corporeal shock wave therapy (lithotriptor)

Heat therapy

Low level laser therapy

Pulsed ultrasound to break up scar tissue, promote healing, and increase blood flow in the area


Trigger point therapy

How can tennis elbow be prevented?

It is often difficult to avoid the sudden onset of tennis elbow. Recommendations to prevent tennis elbow from developing or prevent it from reoccurring:

If playing a sport that uses repetitive movements (such as tennis), get some professional advice about technique in order to avoid strain on the elbow.

Warming up before playing a sport that involves repetitive arm movements (such as tennis or squash) and gently stretching arm muscles will help avoid injury.

Using lightweight tools, or racquets, and enlarging their grip size, will help prevent putting excess strain on tendons. Use of a racket designed to dampen the effect of ball striking.

Increasing the strength of forearm muscles can help to prevent tennis elbow from occurring. A physiotherapist can advise about suitable exercises that will help build up the muscles of the forearm.

If you have tennis elbow:

stop doing the activity that is causing the pain, or find an alternative way of doing it that does not place stress on your tendons. Protect the elbow from further injury by not using the joint. If a particular sport or work activity causes symptoms, stop the activity until your symptoms improve.

Do not use wrist and elbow more than the rest of the arm. Try spreading the load to the larger muscles of the shoulder and upper arm.

Wearing an arm brace, or a wrist splint and taking it off while resting, or sleeping. This can help prevent further damage to the tendons.

Give your elbow a rest but do not avoid all activity. Sometimes, wearing a forearm splint at night helps reduce morning symptoms.

Use a cold pack, ice massage, slush bath or compression sleeve filled with cold water to limit swelling after an injury. Try to apply ice as soon as possible after the injury.

Soft tissue release or massage can help reduce the muscular tightness and reduce the tension on the tendons.

Use an elastic wrap or bandage to compress the injured area.

Keep elbow above heart level when possible to help prevent or limit swelling.

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