Definition

Tennis elbow is soreness or pain on the outside (lateral) side of the upper arm near the elbow.

Alternative Names

Epitrochlear bursitis; Lateral epicondylitis; Epicondylitis - lateral; Tendonitis - elbow

Causes

The part of the muscle that attaches to a bone is called a tendon. Some of the muscles in your forearm attach to the bone on the outside of your elbow.

When you use these muscles over and over again, small tears may develop in the tendon. Over time, the tendon cannot heal, and this leads to irritation and pain where the tendon is attached to the bone.

This injury is common in people who play a lot of tennis or other racket sports, hence the name "tennis elbow." Backhand is the most common stroke to cause symptoms.

But any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to this condition. Painters, plumbers, construction workers, cooks, and butchers are all more likely to develop tennis elbow.

This condition may also be due to repetitive typing on the computer keyboard and mouse use.

People between 35 to 54 years old are commonly affected.

Sometimes, there is no known cause of tennis elbow.

Symptoms

Symptoms can include any of the following:

• Elbow pain that gets worse over time
• Pain that radiates from the outside of the elbow to the forearm and back of the hand when grasping or twisting
• Weak grip

Exams and Tests

Your health care provider will examine you and ask about your symptoms. The exam may show:

• Pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow
• Pain near the elbow when the wrist is bent backward against resistance

An MRI may be done to confirm the diagnosis.

Treatment

The first step is to rest your arm for 2 or 3 weeks and avoid or modify the activity that causes your symptoms. You may also want to:

• Put ice on the outside of your elbow 2 or 3 times a day.
• Take NSAIDs, such as ibuprofen, naproxen, or aspirin.

If your tennis elbow is due to sports activity, you may want to:

• Ask your provider about any changes you can make to your technique.
• Check the sports equipment you are using to see if any changes may help. If you play tennis, changing the grip size of the racket may help.
• Think about how often you play, and whether you should cut back or cross train.

If your symptoms are related to working on a computer, ask your manager about changing your workstation or your chair, desk, and computer setup. For example, a wrist support or a roller mouse may help.

A physical therapist can show you exercises to stretch and strengthen the muscles of your forearm.

You can buy a special brace (counter force brace) for tennis elbow at most drugstores. It wraps around the upper part of your forearm and takes some of the pressure off the muscles.

Your provider may also inject cortisone and a numbing medicine around the area where the tendon attaches to the bone. This may help decrease the swelling and pain.

If the pain continues after rest and treatment, surgery may be recommended. Talk with your orthopedic surgeon about the risks and whether surgery might help.

Outlook (Prognosis)

Most elbow pain gets better without surgery. But most people who have surgery have full use of their forearm and elbow afterwards.

When to Contact a Medical Professional

Contact your provider for an appointment if:

• This is the first time you have had these symptoms
• Home treatment does not relieve the symptoms

References

Adams JE, Steinmann SP. Elbow tendinopathies and tendon ruptures. In: Wolfe SW, Pederson WC, Kozin SH, Cohen MS, eds. Green's Operative Hand Surgery. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 25.

Biundo JJ. Bursitis, tendinitis, and other periarticular disorders and sports medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 247.

Miller RH, Azar FM, Throckmorton TW. Shoulder and elbow injuries. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 46.