You must be hearing this term quite frequently. Also known as 'lateral epicondylitis', is a painful condition that affects the outer aspect of the elbow. Unlike the name suggests, it can affect any individual and not just tennis players.
It involves pain and internal swelling (inflammation) over the elbow and results from overuse or repetitive activities involving the extensor muscles of the forearm and wrist.
Let’s explore some details, such as causes, symptoms, diagnosis, treatment options, and preventive strategies, to help you understand and manage this common problem effectively.
What exactly is ‘Tennis Elbow’?
Tennis elbow is an inflammation or rarely an injury of the extensor carpi radialis brevis (ECRB) muscle of the forearm at the point where it originates from a bony prominence on the outer aspect of the elbow called the lateral epicondyle.
Repeated movements of the wrist and hand, involving tight gripping and twisting (e.g., squeezing or wringing of clothes, sweeping), put excessive stress on the ECRB tendon, leading to inflammation, degeneration, and microtears.The result is constant pain and tenderness on the outer side of the elbow that intensifies with activity.
Who can develop a tennis elbow?
Although tennis players are at an increased risk, anyone who engages in repetitive wrist movements, such as those involved in certain sports or occupations, may develop tennis elbow.
- Common risk groups include:
- Manual labourers: plumbers, carpenters, painters
- Office workers: repetitive typing or mouse use
- Athletes: Tennis, squash, badminton, and golfers
Home makers: doing activities like sweeping, lifting weights, wringing clothes
It commonly affects individuals between 30 and 50 years, but can occur at any age.
What are the causes?
The primary cause is overuse of the forearm extensor muscles, mainly due to:
- Repetitive wrist extension or gripping activities
- Poor technique or weak shoulder muscles in sports like tennis or squash
- Inappropriate equipment (e.g. heavy racquet or tight strings)
- Direct trauma to the elbow
Repetitive stress on the tendon leads to tendinopathy, which initially involves inflammation (tendinitis) and eventually progresses to degeneration (tendinosis). In chronic and recurrent cases, micro tears can be observed.
How to know if you are suffering from tennis elbow?
The prominent symptoms include:
- Sharp pain over the outer aspect of the elbow (lateral epicondyle)
- Pain radiating along the forearm
- Weak grip strength due to pain
- Discomfort when lifting weights, turning a doorknob or using a computer mouse
- Symptoms worsen with wrist extension.
The pain may start as a mild one and worsen over weeks to months, especially with continued activity.
How is it diagnosed?
Diagnosis of tennis elbow is primarily clinical. An orthopaedic surgeon takes a thorough history and performs a physical examination. Key diagnostic manoeuvres include:
- Tenderness just distal to the lateral epicondyle
- Pain with resisted wrist extension with the elbow extended (Cozen’s test)
- Pain on passive wrist flexion with the elbow extended
Imaging is not necessary routinely, but may be helpful in chronic cases:
- X-ray: to rule out other bony pathologies
- Ultrasound: shows tendon thickening (tendinosis)
- MRI: helpful to determine tendon quality and diagnose micro tears
What are the various treatment options?
A. Conservative
Most cases resolve with non-surgical management. Only the timeline for complete recovery may vary. It includes:
- Rest: avoid painful activities
- Cryotherapy: Apply ice packs locally to reduce inflammation
- Bracing: Counterforce elbow straps can reduce strain on the tendons
- Activity modification: Ergonomic adjustments at work or in sports
- Medications: NSAIDs help to reduce pain and inflammation early in the course
- Physical therapy: plays a crucial role in recovery
- Stretching the extensor compartment muscles
- Strengthening shoulder & peri-scapular muscles (especially external rotators)
- Ultrasound therapy
B. Injections
- Corticosteroid: provides short-term relief. Repeated injections are not recommended due to the risk of tendon weakening and tears.
- Platelet-Rich Plasma (PRP): Emerging evidence suggests PRP injections can promote healing by releasing various growth factors
C. Shockwave Therapy
Extracorporeal Shock Wave Therapy (ESWT) can stimulate healing in chronic cases by increasing blood flow and metabolic activity in the tendon area.
D. Surgical Treatment
Surgery is quite rare and considered only after 6 to 9 months of failed conservative treatment. The goal is to remove degenerated tendon tissue, repair the healthy tissue and stimulate healing. Types of procedures include:
- Open release of the ECRB tendon
- Arthroscopic debridement
Post-operative recovery involves short-term immobilisation, followed by a structured rehabilitation program.
How long does it take to recover completely?
Recovery depends on the severity of the condition and compliance with treatment:
- Mild cases resolve in 6–12 weeks with rest and physiotherapy
- Moderate to severe cases may take 3 to 6 months
- Post-surgery, patients can return to heavy activities within 4 to 6 months, depending on progress
Adherence to rehabilitation and exercise regimes is crucial for achieving long-term relief and preventing recurrence.
Is it possible to prevent it altogether?
Yes, it is! Prevention involves minimising repetitive strain and optimising biomechanics.
- Ergonomics: Use proper workstation setup and posture
- Technique correction: professional guidance by a coach in racquet sports
- Strengthening exercises: focus on arm and shoulder muscles
- Stretching: stretches for wrist extensors
- Equipment adjustments: Use lighter racquets, proper grip size, and loosen tight strings
- Warm-up and cool-down: especially before intense arm activity
To summarise, Tennis elbow, though often mild, can significantly interfere with daily life and activities if left untreated.With early diagnosis and conservative management, most individuals recover fully without the need for surgery.If you’re experiencing persistent elbow pain, get it evaluated as early treatment can make all the difference.