What Is Tennis Elbow?

Lateral epicondylitis occurs when the tendons that attach the forearm muscles to the lateral epicondyle, the bony prominence on the outside of the elbow, become irritated or degenerated from overuse. Over time, repetitive stress can cause small tears within the tendon, resulting in pain, tenderness and reduced grip strength. Improper equipment, such as poorly fitted racquets or tools, can also contribute to the development of tennis elbow by increasing strain on the tendons.

Despite its name, tennis elbow is not limited to athletes. It commonly affects individuals whose work or hobbies involve repetitive arm and wrist movements, such as painters, plumbers, mechanics, carpenters, office workers and avid gardeners. Patients often report pain with an insidious onset, typically after engaging in repetitive activities.

Tennis elbow is distinct from medial epicondylitis, also known as golfer’s elbow, which affects the inside of the elbow.

Risk Factors for Tennis Elbow

Tennis elbow, or lateral epicondylitis, can affect anyone, but certain factors can increase your risk of developing this condition.

One of the most common risk factors is participation in racquet sports, such as tennis or squash, which involve repetitive movements of the forearm muscles. However, any activity that requires frequent gripping, lifting or twisting of the wrist can put you at risk. This includes jobs that involve repetitive arm motions, such as construction, manufacturing, plumbing or auto work. Carpenters, painters and assembly line workers are especially prone to overuse injury of the elbow.

Using your dominant arm for repetitive tasks increases the likelihood of developing tennis elbow, especially if improper technique or poorly fitted equipment is used. For example, a racquet with a grip that is too small or tools that are too heavy can place extra strain on the tendons that attach to the lateral epicondyle.

Age is another important factor. People between the ages of 30 and 50 are more likely to experience tennis elbow symptoms, as tendons naturally lose elasticity and strength over time.

Individuals with a history of elbow injuries or conditions affecting the elbow joint may also be at higher risk. Consulting with a physical therapist or orthopedic surgeon can help identify personal risk factors and develop a prevention plan, such as improving technique, using proper equipment and performing targeted exercises to strengthen the forearm and upper arm muscles.

Taking regular breaks, maintaining good posture and warming up before physical activity can also help reduce risk. If symptoms such as persistent elbow pain or weakness develop, seeking evaluation from a healthcare provider is important. Early intervention with conservative treatments such as physical therapy may help reduce pain and promote healing.

Common Symptoms of Tennis Elbow

The primary symptom of tennis elbow is pain on the outside of the elbow. Symptoms typically develop gradually and may worsen over weeks or months. Common signs include:

• Pain or burning on the outer part of the elbow that may worsen with activity
• Tenderness over the lateral epicondyle
• Weak grip strength
• Pain with lifting, gripping, shaking hands, turning a doorknob or using tools, such as lifting a coffee cup
• Increased discomfort with repetitive wrist or forearm activity

Pain may start slowly or develop suddenly and is often aggravated by movements that strain the affected tendons. Diagnosis can be supported by pain reproduced during resisted wrist extension, which helps localize symptoms to the affected region.

Symptoms often affect the dominant arm, though both arms can be involved.

What Causes Tennis Elbow?

Tennis elbow is primarily caused by repetitive overuse of the forearm muscles and tendons. Contributing factors may include:

• Repetitive gripping or wrist extension motions
• Improper technique during sports or physical activities
• Occupational strain from manual labor or repetitive tasks
• Age-related tendon degeneration, most commonly between ages 30 and 50

In some cases, tennis elbow may develop without a clear triggering activity. Other conditions, such as nerve entrapment or stress injuries, can present with similar symptoms and should be considered during evaluation.

How Tennis Elbow Is Diagnosed

Diagnosis of tennis elbow typically begins with a thorough medical history and physical examination. At OrthoTexas, your physician evaluates pain location, strength, range of motion and functional limitations. Pain reproduced during resisted wrist extension often supports the diagnosis.

Diagnostic imaging may be used when needed to rule out other conditions or evaluate tendon integrity. These may include:

• X-rays to assess bone structure and rule out arthritis
• Magnetic resonance imaging (MRI) to evaluate soft tissues, tendon damage or other causes such as nerve compression

Conditions that can mimic tennis elbow, including radial tunnel syndrome or other nerve-related issues, may also be considered during evaluation.

Treatment Options for Tennis Elbow

Most cases of tennis elbow are successfully managed with conservative care. Many patients experience pain relief within 12 months of nonsurgical treatment. OrthoTexas emphasizes conservative treatment before considering surgery, which is typically reserved for persistent cases.

Nonsurgical Treatment Options

Approximately 90 to 95 percent of patients improve without surgery. Nonsurgical treatments may include:

• Activity modification and rest from aggravating movements
• Physical therapy focused on stretching, strengthening and tendon healing
• Bracing or counterforce straps to reduce tendon strain
• Wrist splints to limit repetitive motion
• Anti-inflammatory medications, such as ibuprofen or naproxen
• Ice therapy to reduce inflammation
• Corticosteroid injections for short-term symptom relief, with careful consideration of risks

The natural course of tennis elbow is favorable, with spontaneous recovery within one to two years in most patients.

Surgical Treatment for Tennis Elbow

Surgery is rarely needed and is considered only after 6 to 12 months of consistent nonsurgical treatment without improvement. Surgical options aim to remove damaged tendon tissue and promote healing and may include open or arthroscopic procedures. These are typically performed on an outpatient basis and followed by structured rehabilitation.

Recovery and Prevention

Recovery timelines vary depending on severity and treatment approach. Rest, adherence to rehabilitation programs and gradual return to activity are essential. To help prevent tennis elbow or reduce recurrence:

• Stretch and strengthen forearm muscles regularly
• Use proper technique during work and sports activities
• Avoid repetitive strain without adequate rest
• Use appropriate tools and ergonomic supports
• Warm up before physical activity

When to See a Doctor

Medical evaluation is recommended if elbow pain persists for several weeks despite rest, interferes with daily activities or work or is accompanied by weakness or worsening symptoms.

Expert Tennis Elbow Care at OrthoTexas

Tennis elbow can significantly impact your ability to work, exercise and enjoy everyday activities. At OrthoTexas, our experienced orthopedic physicians, physical therapists and care teams provide comprehensive treatment for elbow conditions.