Tennis elbow is one of the most common overuse injuries of the upper limb, affecting athletes and non-athletes who perform repetitive wrist and forearm tasks. Understanding what’s happening at the tendon—and how to manage load—can accelerate recovery and reduce recurrences.
What Is Tennis Elbow?
Tennis elbow (lateral epicondylitis) describes pain on the outside of the elbow where the common extensor tendons (especially extensor carpi radialis brevis) attach to the lateral epicondyle. Repetitive gripping, wrist extension, or forearm rotation leads to micro-tearing and degenerative changes (tendinopathy) at this tendon origin. Although racquet sports can provoke it, so can painting, typing, carpentry, and tool use. Most cases are self-limited with appropriate load management and rehabilitation.
Common Symptoms of Tennis Elbow
Hallmark signs include localized tenderness over the lateral epicondyle, pain with resisted wrist or middle-finger extension, and reduced grip strength. Daily tasks like turning a doorknob, shaking hands, pouring a kettle, or lifting a pan may flare symptoms. Some people feel aching into the forearm or wrist; severe cases can hurt at rest. A careful exam also screens for nerve entrapment or referred pain from the neck or shoulder.
Causes and Risk Factors
The underlying problem is cumulative tendon overload that outpaces its capacity to heal. Risk rises with repetitive manual tasks, poor ergonomics, abrupt spikes in activity, and technique or equipment issues (e.g., stiff racquet strings, heavy tools). Peak incidence is ages 30–50 but it can occur outside that range. Occupations with forceful, repetitive wrist extension and forearm rotation—mechanics, cooks, carpenters—are commonly affected.
Diagnosis
Diagnosis is clinical: history plus targeted tests (e.g., Cozen’s or Mill’s). Imaging (X-ray, ultrasound, MRI) isn’t required in straightforward cases but can rule out arthritis, fracture, or tendon tear when presentation is atypical or symptoms persist despite care. If nerve symptoms dominate (numbness/tingling), clinicians may consider electrodiagnostic testing to rule out radial tunnel or cervical radiculopathy.
Effective Treatment Options
- Relative rest & activity modification. Temporarily dial down aggravating tasks (especially sustained gripping and wrist extension) while staying generally active.
- Medication. Short courses of NSAIDs can reduce pain; topical NSAIDs may help with fewer systemic effects—ask your clinician about risks and interactions.
- Bracing. A counterforce forearm strap (worn 2–3 finger-breadths below the epicondyle) can reduce tendon strain during tasks.
- Physical therapy. Strong evidence supports exercise-based care—progressing from isometrics to eccentric/concentric strengthening of the wrist extensors, with shoulder/scapular strengthening, manual therapy as appropriate, and graded exposure to provocative tasks.
- Injections and procedures. Corticosteroid injection may provide short-term relief but often underperforms exercise-led care at intermediate follow-up; platelet-rich plasma data are mixed. Recalcitrant cases (after 6–12 months of comprehensive non-operative care) may be candidates for surgical debridement or tendon repair. Dextrose prolotherapy is a regenerative medicine technique that utilizes “sugar water” and aims to stimulate the body’s natural healing process to repair and strengthen weakened or injured connective tissues like ligaments and tendons. It often needs to be performed in a series of injections for maximal benefit. This is similar in some ways to Platelet Rich Plasma (PRP), which is another regenerative medicine technique that utilizes one’s own concentrated platelets to promote healing of damaged tendons. This is typically intended to be performed as a “one and done procedure” and is considered a promising option for long-term relief, especially when other treatments like cortisone injections or physical therapy have failed. Both of these options are not yet covered by insurances.
Preventive Measures and Exercises
Technique & ergonomics. Use tools with larger, cushioned grips; reduce sustained pinch; consider racquet grip size and string tension. Alternate tasks and schedule micro-breaks.
Foundational exercise routine (3–5 days/week, pain-guided progressions):
- Isometric wrist extension (elbow by side, neutral wrist): 5 × 30–45-second holds.
- Eccentric wrist extension (lowering phase emphasized) with light dumbbell: 3 × 12–15.
- Radial deviation & supination/pronation control with light resistance: 2–3 × 12.
- Proximal conditioning (scapular retraction, external rotation, serratus work): 2–3 × 12–15.
- Stretching of wrist extensors: 20–30 seconds × 3.
AAOS provides a free, printable handout demonstrating a phased exercise program for epicondylitis; it’s a practical visual resource to pair with therapy: https://orthoinfo.aaos.org/globalassets/pdfs/a00790_therapeutic-exercise-program-for-epicondylitis_final.pdf
Conclusion
Tennis elbow reflects an overloaded tendon—not a permanently damaged one. With load management, a structured exercise program, and attention to technique and ergonomics, most people recover without surgery. If symptoms persist despite several months of disciplined care, discuss additional options (including injections or surgery) with your clinician.
Sources:
AAOS OrthoInfo. (n.d.). Tennis elbow (lateral epicondylitis).https://orthoinfo.aaos.org/en/diseases–conditions/tennis-elbow-lateral-epicondylitis/OrthoInfo
AAOS OrthoInfo. (2019). Therapeutic exercise program for epicondylitis (PDF). https://orthoinfo.aaos.org/globalassets/pdfs/a00790_therapeutic-exercise-program-for-epicondylitis_final.pdfOrthoInfo
Buchanan, B. K., & Varacallo, M. (2023). Lateral epicondylitis (tennis elbow). StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK431092/NCBI
JOSPT/APTA. (2022). Lateral elbow pain and muscle function impairments: Clinical practice guideline.https://www.jospt.org/doi/10.2519/jospt.2022.0302JOSPT
Mayo Clinic. (2025). Tennis elbow—Diagnosis & treatment.https://www.mayoclinic.org/diseases-conditions/tennis-elbow/diagnosis-treatment/drc-20351991Mayo Clinic
Hohmann, E., et al. (2023). Corticosteroid vs PRP for lateral epicondylitis: Updated meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 31, 3335–3348. https://pubmed.ncbi.nlm.nih.gov/37247780/PubMed
This information has been medically reviewed by Cody Franzen, M.D., Primary Care Sports Medicine provider at Olympia Orthopaedic Associates.
IMPORTANT: This content is for general information and education only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any condition. Do not use this information to make decisions about your health without speaking with a qualified healthcare professional who can provide advice tailored to your situation. If you have symptoms, an injury, or a medical concern, contact your healthcare provider. If you may be experiencing a medical emergency, call your local emergency number immediately.