Tennis Elbow (Lateral Epicondylitis)

What Is Tennis Elbow (Lateral Epicondylitis)?

Tennis elbow is a type of tendon inflammation or tendinosis. This overuse injury occurs when repetitive movements irritate, inflame and damage tendons, causing elbow pain. 

The condition is called tennis elbow because it commonly affects people who play a lot of tennis or other racket sports like pickleball and squash. However, any repetitive gripping, twisting or swinging motion that bends your hand up or backward (wrist extension) can cause tennis elbow. 

What are other names for tennis elbow?

Lateral epicondylitis is the medical term for tennis elbow. The epicondyle is the bony bump that you can feel on the outer (lateral) side of your elbow. Tendons attach forearm muscles to this bony bump. 

What does tennis elbow feel like?

Tennis elbow causes pain in the outside of your elbow over the bony bump. Without rest or treatment, this pain gradually worsens. 

Most people develop tennis elbow in their dominant arm, but it can affect both arms. Signs of tennis elbow include:

• Aching or stabbing sensation on the outer side of your elbow
• Difficulty holding objects (weak grip)
• Outer elbow that’s tender to touch
• Pain that worsens at night or when you grip or lift items

When should you see a medical professional?

You should see your primary care physician if you have chronic, severe elbow pain or grip weakness that makes it difficult to engage in daily tasks and activities. 

Your doctor may refer you to one of these specialists:

• Orthopedic doctor
• Orthopedic surgeon
• Physical medicine and rehabilitation specialist (physiatrist)
• Sports medicine doctor

Why do you get tennis elbow?

Repetitive stress on tendons in your elbow can cause small tears (microtears), leading to chronic inflammation. Scar tissue forms as the tendon tries to repair itself. 

Tendons in your elbow help you move muscles that control wrist, hand and finger movements. Tennis elbow affects the tendon that attaches the extensor carpi radialis brevis muscle in your forearm to the bony outer bump. This muscle helps you straighten and extend your wrist.

Less commonly, an arm or elbow injury causes tennis elbow. In some cases, there’s no apparent cause (idiopathic lateral epicondylitis).

Are you at risk for tennis elbow?

You don’t have to play tennis or any sport to get tennis elbow.

Any activity that involves repetitive, prolonged or vigorous use of your forearms, wrist and hand can cause this painful condition. Tennis elbow most commonly occurs in people between 30 and 50 years old. 

These factors increase your risk:

• Repetitive gripping actions, such as painting, carpentry work, gardening, cooking, auto repair and plumbing
• Regularly lifting heavy objects
• Trauma to your elbow
• Using the wrong technique or equipment in a sport, hobby or job

How do doctors diagnose tennis elbow?

Your doctor will ask about your symptoms, including the activities that cause or worsen symptoms. They’ll perform a physical exam to check for elbow pain and tenderness.

You may also get one or more of these tests:

• X-ray: An X-ray of bones in your elbow can help rule out other conditions, such as rheumatoid arthritis and osteoarthritis. 
• MRI: An MRI can show damage to tendons, muscles and other tissues. It can help your doctor rule out other conditions that cause arm pain, such as a herniated disc in your neck.
• Electromyogram (EMG): An EMG study checks for compressed nerves in your arm, which can cause elbow pain.

How do doctors treat tennis elbow?

Treatments for tennis elbow depend on symptom severity, as well as how the condition affects your daily life and ability to be active.

In most cases, tennis elbow will get better on its own, but healing can take up to a year. Our doctors offer nonsurgical treatments to help you recover faster.

Treatments for tennis elbow include:

Physical therapy

Physical therapists can teach you how to safely perform eccentric loading exercises. These exercises stimulate tissue repair and strengthen muscles and tendons between your elbows and wrists (forearm). With eccentric loading, you hold a dumbbell in the hand of the affected arm and slowly lower it. The slow movement puts tension on tendons and muscles in the forearm, strengthening and stretching them.

For the best results, you should:

• Go to physical therapy for at least three months.
• Do eccentric loading exercises at home every day for at least three months.
• Continue to do eccentric loading exercises at home as prescribed by your physical therapist for up to one year.

Topical nitroglycerin (patch)

A nitroglycerin patch applied to skin over the injured area can widen local blood vessels. As a result, more blood reaches the tendon, helping it to heal faster. Your provider may recommend wearing a patch every day for three to six months while you also participate in physical therapy.

Extracorporeal shock wave therapy

Your provider uses a handheld device to send shock waves (also called pressure waves) through your skin to the inflamed tendon. The pressure waves break up thickened scar tissue. The treatment also brings more blood to the damaged tendon, stimulating the body’s natural ability to heal. You may get this once-a-week treatment for four to six weeks.

Prolotherapy

Prolotherapy (proliferative therapy) involves injecting a sugar water solution (dextrose) around damaged tendons. Dextrose acts as a chemical irritant. It causes mild inflammation that spurs the body into action to repair the tissue. You may need prolotherapy every month for three to five months.

Platelet-rich plasma (PRP) injections

PRP therapy uses an injection of your own blood to promote healing. You receive an injection of plasma (the liquid part of blood) that has a higher concentration of platelets. Platelets carry growth factors that aid tissue repair and reduce inflammation. Depending on your symptoms, you may need one to three treatment sessions several weeks apart.

During PRP therapy, a healthcare provider:

• Draws a few vials of your blood 
• Uses a centrifuge machine to separate platelets from other blood cells
• Uses the centrifuge to then concentrate the platelets
• Filters the concentrated platelets and plasma for injection
• Injects the platelet-rich plasma around the injured elbow tendon

Percutaneous needle tenotomy

A percutaneous needle tenotomy is a minor surgical procedure that involves puncturing the damaged tendon with a needle. The treatment breaks up scar tissue and causes the body to send more blood to the injured area. Cells then begin to repair and rebuild the tendon. After this procedure, you’ll wear a wrist brace for a couple of weeks to protect and immobilize the tendon that controls wrist movements.

During this outpatient procedure, your provider:

• Injects a local anesthetic to numb the treatment site
• Uses ultrasound technology to guide the insertion of a needle through the skin into the tendon
• Pierces various sections of the damaged tendon with the needle, breaking up scar tissue

Elbow surgery

In rare instances, you may need elbow surgery. When possible, our orthopedic surgeons perform minimally invasive elbow arthroscopy. During this procedure, your surgeon:

• Makes two or more small incisions in your elbow
• Inserts a tiny scope device with a camera and light (arthroscope) into an incision 
• Views the camera images to repair the tendon and remove damaged tissue using tiny surgical instruments inserted into the other small incisions

In some cases, a surgeon may need to perform open elbow surgery through a larger incision. Both of these procedures are typically outpatient, which means you go home the same day. After surgery, you’ll wear a brace or cast from your elbow to wrist for up to four weeks while the tendons heal. 

What’s the outlook when you have tennis elbow?

Between 80% and 95% of people with tennis elbow get better with nonsurgical treatments.

However, you can have tennis elbow again if you don’t give your body enough time to heal and recover. Your doctor may recommend limiting certain activities for a short period of time. If symptoms worsen or continue for more than six months, you may need to see an orthopedic surgeon.

Can you prevent tennis elbow?

Yes, certain actions can help lower your risk of tennis elbow and ease elbow pain.

You can:

• Apply ice to ease painful swelling.
• Change how you grip, hold or lift objects.
• Strengthen your arm muscles, specifically in the forearm.
• Switch to different equipment, such as a lighter racquet or one with a smaller grip size.
• Take breaks from repetitive activities when necessary.
• Use a wrist support when using a keyboard or mouse.
• Wear a supportive elbow brace.