What is Tennis Elbow?

The term 'tennis elbow' originated from its prevalence among tennis players; however, this condition extends beyond this group. It is commonly linked to movements requiring wrist and arm extension or twisting which are typical in various sports and manual labour jobs. The main symptom involves experiencing pain that spreads from the part of the elbow down to the forearm. Recognizing the mechanisms and symptoms of tennis elbow is essential for early identification and effective treatment.

While tennis elbow impacts 1-3% of the population it is more frequently observed in tennis players with estimates indicating that 35-50% of players may encounter it during their careers. This condition is also prevalent among participants in racket sports like squash and badminton. Detecting and addressing it are crucial steps towards preventing prolonged symptoms and potential disability caused by tennis elbow.

  • Tennis elbow earned its name from its prevalence among tennis players in the late 19th century. 
  • The term "lateral epicondylitis" refers to the location on the humerus bone in the upper arm known as the lateral epicondyle. 
  • Despite its moniker, tennis elbow is not exclusive to athletes and can affect individuals in various professions that involve repetitive arm movements.

An Overview of Elbow Anatomy and Function

The elbow serves as a junction for three bones: the upper arm bone (humerus) and the two forearm bones (radius and ulna). Muscles, ligaments and tendons collaborate to uphold this joint enabling both movement and stability. Tennis elbow results from strain or excessive use of the extensor carpi radialis brevis (ECRB) muscle leading to discomfort and sensitivity at its connection point, on the upper arm bone (epicondyle).

The ECRB muscle plays a role in wrist extension and stability, especially during activities involving gripping motions. Continuous utilisation of this muscle during tasks requiring twisting actions can cause small tears in the tendon. Over time these tears may lead to inflammation and discomfort which are typical symptoms of tennis elbow.

To fully comprehend why certain activities can increase the risk of this condition and how to effectively treat and prevent it, having an understanding of the involved anatomy is crucial.

The elbow joint allows for two movements: bending and straightening (flexion/extension) and rotating (supination/pronation) of the forearm. One of the wrist extensor muscles originating from the epicondyle is the ECRB muscle. These muscles are involved in activities such as gripping, lifting and twisting of the forearm and wrist. The repeated contraction of the ECRB muscle is notably associated with the onset of tennis elbow.

  • The elbow joint comprises three connections between the humerus, radius and ulna bones.
  • The ECRB muscle is one of more than 20 muscles that cross over at the elbow joint.
  • The blood supply to the ECRB tendon is relatively limited which could contribute to its vulnerability to overuse injuries.

Tennis Elbow Causes

Recognizing causes plays a key role in understanding what tennis elbow entails. Overuse or straining of forearm muscles and tendons leads to inflammation and pain. Excessive use often stems from repeated movements that require grasping, turning or lifting. Various specific activities and jobs are commonly linked to tennis elbow, such as playing racket sports, manual labour like plumbing and carpentry, prolonged computer usage, gardening and cooking professions that entail cutting and stirring actions. It's worth noting that while these activities can contribute to the onset of tennis elbow the condition can also manifest spontaneously without a trigger. The likelihood of developing tennis elbow rises with age, with cases appearing in individuals aged between 30 and 50. Other risk factors include engaging in racket sports smoking, being overweight and having occupations or hobbies involving wrist and forearm movements. Utilising ergonomic practices and staying physically fit are crucial preventative measures for avoiding tennis elbow.

  • When it comes to playing tennis using the wrong backhand technique can often lead to tennis elbow especially if you're using a racquet that is too big or relying much on your wrist for the stroke.
  • Painters, plumbers and carpenters are at risk of developing tennis elbow due to repetitive movements like brushing, gripping and twisting.
  • Hairdressers and chefs also frequently experience tennis elbow from actions like styling hair or cutting ingredients.

Tennis Elbow Causes

Tennis Elbow Signs and Symptoms

Recognizing the indications and effects of tennis elbow is vital for its identification and care. A typical symptom involves feeling discomfort originating from the area of the elbow, which might spread to the forearm and wrist. This discomfort often intensifies during activities, especially ones that require gripping or lifting.

Other notable symptoms include tenderness directly over the bony bump on the side of the elbow (lateral epicondyle), weakness when gripping or lifting objects, stiffness in the elbow in the morning, occasional warmth or swelling in the area. The pain usually progresses gradually from discomfort to worsening over weeks or months. It can be aggravated by tasks like lifting objects using tools, shaking hands or even simple movements like turning a doorknob.

In chronic cases of tennis elbow individuals may experience pain even when at rest. 

Symptoms such as weakness and tightness in the forearm and wrist can worsen over time, impacting tasks. Identifying these signs can help with better management and reduce the chances of the condition becoming chronic.

  • Pain on the side of the elbow that spreads to the forearm is a key indicator of tennis elbow.
  • Having trouble with grip strength, such as opening jars is an issue associated with tennis elbow.
  • Occasionally pain from tennis elbow may extend down to the wrist and fingers.

Who is Vulnerable? 

Recognizing the individuals to tennis elbow aids in preventing and detecting it early. While the ailment is commonly connected with athletes, tennis players it can impact diverse groups of people. Risk factors extend beyond sports. Encompass various demographic and job related aspects.

Age stands out as a risk factor with the majority of tennis elbow cases manifesting in individuals aged 30 to 50. Occupations involving movements of the wrist and forearm like plumbing, painting, carpentry, automotive work and meat cutting elevate the risk of developing tennis elbow. This risk also extends to sports beyond just tennis. Any racket sport, fencing and weightlifting also heighten the susceptibility.

Specific lifestyle choices and medical conditions can also contribute to an increased risk for tennis elbow. Smoking, obesity as well as conditions such as diabetes and arthritis have all been associated with a higher likelihood of developing this condition. Additionally, having a history of elbow injury or strain elevates an individual's susceptibility. Recognizing these risk factors is vital for implementing targeted prevention measures and early intervention for those prone to the ailment.

  • Both men and women can develop tennis elbow. 
  • This condition impacts up to 50% of tennis players during their careers those aged 35 and above. 
  • Occupations that require wrist and forearm movements, such as plumbing and painting have rates of tennis elbow that are up to 5 times higher compared to the general population.

Diagnostic Procedures

Diagnosing tennis elbow requires a method that incorporates a clinical assessment with precise diagnostic evaluations. It begins with gathering the patient's history, where healthcare professionals ask about the nature and onset of symptoms, activities, work duties and participation in sports.

Upon reviewing the patient's background, the doctor will carefully examine the elbow, forearm and wrist to look for any indications of tenderness, swelling or weakness. For a differential diagnosis of tennis elbow, the doctor often administers tests, like the Cozen's test. During this test, the patient is instructed to make a fist, rotate their forearm inward and then extend their wrist while facing resistance from the examiner. If there is pain or weakness during this action it could indicate tennis elbow. Other tests like the Mill's test and chair lift test are also used to assess pain during resisted wrist extension and lifting objects.

In some cases, a healthcare provider may diagnose tennis elbow based on the patient's history and physical examination. If there is uncertainty in the diagnosis or if symptoms persist despite treatment, additional imaging tests may be necessary. X-rays can help rule out conditions like arthritis or fractures that could be causing elbow pain. Advanced imaging techniques such as ultrasound or MRI might be recommended for an evaluation of the tendons and soft tissues around the elbow if required.

  • It's worth noting that over 90% of individuals with tennis elbow show a result on the Cozen's test.
  • Grip strength on the side is commonly reduced in tennis elbow when measured using a dynamometer.
  • Advanced imaging techniques such as ultrasound or MRI are typically unnecessary unless there is uncertainty in diagnosis or symptoms do not improve with treatments.

Treatment Approaches for Tennis Elbow

The management of tennis elbow usually begins with conservative measures and may progress to more invasive interventions based on symptom severity and duration. Initial treatment primarily involves rest and modifying activities. This includes identifying and adjusting or avoiding activities that trigger pain, such as wrist and forearm movements. Alongside rest, splinting or bracing can be used to reduce strain on the affected tendons.

Physical therapy is important in treating tennis elbow without surgery. A therapist can provide advice on exercises to stretch and strengthen the muscles in the forearm aiding in recovery and reducing the risk of issues. Moreover, treatments such as ice, heat, ultrasound or electrical stimulation may form part of the rehabilitation plan.

Medications are commonly employed alongside treatments to manage pain and inflammation associated with tennis elbow. Initial options often include over the counter pain relievers such, as acetaminophen or ibuprofen.

For intense pain, a physician might recommend stronger anti-inflammatory medications or even a brief course of oral corticosteroids. If oral drugs don't work, corticosteroid injections into the affected area could offer more potent localised anti-inflammatory effects although there is ongoing debate about their long term effectiveness.

  • About 90% of tennis elbow cases improve with conservative treatment within one year.
  • Eccentric strengthening exercises have proven particularly effective in rehabilitating tennis elbow.
  • While corticosteroid injections can temporarily alleviate pain, they are associated with high rates of symptom recurrence and are becoming less favoured as a treatment option.

Treatment Approaches for Tennis Elbow

Rehabilitation and Exercises

Rehabilitation and exercise play roles in recovering from tennis elbow. The main objectives of rehabilitation include promoting healing, rebuilding strength and flexibility, and gradually resuming activities while minimising the chances of recurrence. A typical rehabilitation program advances through phases, starting with pain management and gentle movements, before progressing to targeted stretching and strengthening exercises.

During the first phase, emphasis is placed on rest, ice therapy and gentle pain free exercises to improve the range of motion, for the elbow, wrist and fingers. As pain diminishes, stretching routines are incorporated to enhance the flexibility of forearm muscles.

Typical wrist stretches involve stretching the muscles that help extend and flex the wrist as those that involve rotating the forearm outward. These stretches are usually held for 15 to 30 seconds each time. Repeated multiple times, throughout the day.

As symptoms improve and stretching gets easier, the rehab plan shifts to exercises focused on building muscle strength. Eccentric exercises, which emphasise muscle extension are known to be particularly beneficial for tendon healing. These exercises may start with wrist extension movements using weights or resistance bands and progress to functional actions, like gripping objects and twisting motions. It's important to do strengthening exercises in a controlled manner while avoiding any discomfort.

  • Studies have shown that stretching and eccentric strengthening exercises are more effective than ultrasound therapy or massage in treating tennis elbow.
  • The Tyler Twist is a known eccentric exercise for tennis elbow involving a flexible rubber bar.
  • The duration of rehabilitation for tennis elbow can vary from weeks to several months depending on how severe the condition is.

Lowering the Risk of Tennis Elbow

Preventing tennis elbow largely revolves around addressing risk factors and biomechanical issues that contribute to this condition. For athletes involved in racquet sports, using appropriate equipment and proper technique is essential.

Choosing the tennis racquet involves finding one that fits your size and skill level and ensuring it's strung correctly. Racquets that are big or tightly strung can increase the impact on your arm.

It's also crucial to use techniques to reduce strain on your elbow. In tennis, this often means focusing on a backswing and follow through for backhand shots instead of relying too much on wrist movements. Getting guidance from a certified instructor can help you master these techniques. Doing exercises to strengthen the forearm muscles through cross training can also prevent injuries caused by overuse.

For individuals with jobs that require wrist and forearm actions, making ergonomic changes and using correct body mechanics are essential for prevention. This might include adjusting tool grips, using power tools instead of manual ones or varying tasks to avoid prolonged repetitive movements. Maintaining physical fitness, warming up adequately before activities and stretching regularly are additional strategies to lower the chances of developing tennis elbow.

  • Using a dampener or switching to a flexible racket can help reduce vibration and shock in tennis.
  • Simple tools like ergonomic scissors and openers can greatly benefit hairdressers and chefs who are prone to tennis elbow.
  • Wearing a counterforce brace during activities could aid in preventing tennis elbow by redirecting forces from the tendon.


In conclusion, though dealing with tennis elbow can be challenging, most cases respond well to treatments over time. Early identification, modifying activities and following a rehabilitation program focusing on flexibility and strengthening the forearm muscles are key. For individuals at risk, preventive measures such as using appropriate equipment, maintaining proper mechanics and considering ergonomics play crucial roles in maintaining elbow health. By combining rest, rehabilitation and preventive strategies, individuals with tennis elbow can often resume their sports and activities without enduring lasting restrictions.