Signs, Symptoms and Treatment for Lateral Epicondylitis (Tennis Elbow)

lateral epicondylitis

Only about 5 percent of tennis elbow cases are actually caused by playing tennis. The majority of people who come down with tennis elbow, formally called lateral epicondylitis, get it as the result of everyday activities at work or home.

Because lateral epicondylitis has become popularly associated with tennis, many non-tennis players assume it can’t happen to them. Keep reading now to learn about this condition, its causes and symptoms, and how to know if you are at risk.

What Is Lateral Epicondylitis?

What is tennis elbow? Tennis elbow is the informal name of lateral epicondylitis, which pain specifically over the bony prominence where the muscle and fascia of the extensor tendons attach at the elbow.

“Tennis Elbow, or Lateral epicondylitis, is simply overuse of your extensor tendons,” says Dr. Khorsandi, hand surgeon at HSST.

Your elbow joins your humerus or upper arm bone to your radius and ulna, the bones in your forearm. The elbow joint itself is made of muscles, ligaments, and tendons.

The main tendon in your elbow that is usually responsible for tennis elbow pain is called the Extensor Carpi Radialis Brevis (ECRB). This tendon attaches to your bones at protrusion called the lateral epicondyle, which is where the name lateral epicondylitis comes from.

Tennis elbow occurs when the ECRB is overworked. The tendon may be torn or just strained. In either case, it weakens, becoming inflamed and painful.  Dr. Khorsandi, also says that sometimes the fascia, or the outer layer that envelopes the muscle in this region can become simply too tight or restrictive on the muscle contained within it.  Thus the muscle wants to expand, but it is limited due to the tight tissue and fascia, resulting in pain.

What Causes It?

Tennis elbow is a repetitive motion injury. It is caused by repeatedly moving your hands, arms, and elbows in the same motion over and over. This movement rubs the tendon against the bony protrusions in your bones at your elbows, causing micro-tears, inflammation, and the pain that characterizes the condition.

It’s Not Just Tennis

Tennis elbow got its common name because the injury frequently happens to tennis players. It is particularly common in players who weren’t taught or don’t use proper technique on their backhand strokes.

The vast majority of suffers are not tennis players, however. Other hobbies that are known to cause tendonitis elbow include:

Many elbow tendonitis sufferers acquire the condition as the result of their work. Professions at high risk include:

  • Plumbers
  • Construction workers
  • Carpenters
  • Butchers
  • Cooks
  • IT Professionals
  • Autoworkers

Anyone who engages in repetitive hand, wrist, or arm movement at work or during pleasure activities may be at risk.


Tennis elbow can happen at any age. It is most common between adults 30 to 50 years old, however.

Insidious Cases

Occasionally, adults can come down with tennis elbow without engaging in any observable repetitive motion activities. These cases are referred to as “insidious cases.”

Impacts of Tennis Elbow on Quality of Life

The weakness that results from tennis elbow can make it difficult for suffers to grasp or lift objects. This can seriously complicate the activities of daily living. Individuals can struggle to:

  • Eat and drink
  • Bathe and dress themselves
  • Open and close doors
  • Drive
  • Write or operate a keyboard
  • Pick up or carry objects

Simply moving through one’s day can be challenging. Engaging in one’s favorite hobbies or caring for another person can be difficult or impossible.

Tennis elbow can have also seriously impact sufferers’ ability to work. The personal challenges to personal care and mobility limit their ability to get to work in the first place. Once they are at work, they are often unable to use the tools required to do their jobs.

Extreme, constant pain can make thinking, focusing, and completing tasks difficult. Jobs that require the use of the injured arm can be impossible. Ultimately, if tennis elbow is left untreated or if it does not respond to treatment, it can drive people out of the workplace entirely.

In extreme cases, it can lead to disability and a permanent loss of wages. Nationally, the condition accounts for significant loss of productivity in the workplace and substantial health care expenses. It is a burden that both workers and employers share.

Tennis Elbow Signs and Symptoms

The primary symptoms of tennis elbow are pain and weakness.

Tennis elbow pain is very specific. It is focused on the outside of your elbow, near the bottom of the joint. In some cases, the pain extends down to include your forearm and your wrist.

The pain can come on without warning and may be extreme. It may get worse when you attempt to grip or squeeze something with your hand. The pain may also flare up particularly badly when you use your hand or arm in the repetitive motion that caused the injury.

The weakness associated with tennis elbow affects elbows, wrists, and hands. You may find that you have trouble holding onto glasses or mugs, manipulating doorknobs, or picking up objects like pencils or keys.


Lateral epicondylitis may set in all at once with no clear inciting incident. Alternatively, it can start out as mild or occasional pain but gradually get worse over a long period of time.

Left untreated, the pain associated with tennis elbow can become a constant, intense agony.

It is possible to have tennis elbow just one arm or in both arms at the same time. About two-thirds of sufferers get it in their dominant arms. Women are slightly more likely to suffer from tennis elbow than men.

What You Won’t See

Tennis elbow symptoms are not externally visible. Sufferers do not experience bruising, redness, visible swelling, rashes, or other outward signs of their injuries.


If you suspect that you have lateral epicondylitis, you should consult with your doctor. It is impossible to accurately diagnose tennis elbow yourself, as there are other numerous other conditions with similar symptoms that it might be confused for.

There is no direct test that your doctor can use to determine if you are suffering from tennis elbow. Instead, he or she will use a combination of assessments to verify that you are suffering from the condition.

First, your doctor will review your symptoms and your personal medical history. They will ask your work and home activities, looking for actions or situations that might cause a repetitive strain injury. It is important to tell your doctor about all of your activities and injuries during this stage so that they can make an accurate diagnosis.

Your doctor may then palpate or carefully move your arm. They will ask you about your pain levels as it moves, and look for patterns and correlations.

In some cases, your doctor may use medical imaging techniques to further explore your condition and rule out other possible causes. For example, they may take X-rays to look for arthritis or an EMG to check for nerve damage. They may use an MRI to make sure the pain is not related to a herniated disk which can cause similar symptoms.

Together, these approaches will allow your doctor to determine if you have tennis elbow and, if so, how severe it is.

First-Line Treatments

In its mildest forms, lateral epicondylitis is often treatable to simple therapies and over-the-counter medications. Your doctor may recommend rest and pain relievers such as aspirin or ibuprofen for the pain.

Ergonomic modifications

“Sometimes just changing your work space at work or form at play can make a huge difference in treating tennis elbow,” commented Houston hand surgeon Dr. Khorsandi.  He states that you can change the type of keyboard, mouse, desk height, and much more.  In sports, your form could impact how much stress / pain you have localized to the lateral epicondyle.  Many corporate offices have consultants to help with ergonomic modifications.

Change How You Move

Your doctor may recommend that you take a break from repetitive motion activities, if possible. This may require exploring new hobbies or seeing if you can get temporarily reassigned at work to give your body a chance to rest and heal.

Stretching Exercises

Simple wrist and forearm stretches can help. Your doctor may teach you some of these stretches and assign you a frequency with which to do them. They may also teach you simple self-massage techniques to help with the pain.


Your doctor may recommend using a brace to support your arm and limit the strain on your abused tendon. Compression sleeves may also help.

Heat or Ice

Applying heat or ice per your doctor’s instructions can speed up the healing process. You may also be instructed to elevate your arm while heating or icing it.

Dietary Changes

In some cases, removing inflammatory foods like sugar, grains, dairy, and red meat from your diet can help speed up your healing. Your doctor may also prescribe supplements that enhance your body’s ability to heal itself quickly.

Other Options

Some doctors may suggest pursuing acupuncture, extracorporeal shock wave therapy, and other alternative healing modalities. These options are less widely accepted but are not entirely uncommon.

More Advanced Treatments

If your tennis elbow pain does not respond to first-line interventions in six months to a year, more intensive treatment may be needed. Examples include:

  • Periodic corticosteroid injections to reduce swelling ease pain
  • Ultrasound treatment to promote blood flow and healing
  • Physical therapy

Between 80 and 95 percent of cases respond to these treatments and do not require surgery. If your pain and weakness do not change, however, surgery may become necessary. There are two forms of lateral epicondylitis surgery.

Both forms involve cutting away damaged muscle or tendon and attaching what remains to the bone in place of the removed section. Both types of surgery are outpatient procedures that do not involve overnight hospital stays except in rare conditions.

Open Surgery

Open surgery is the most commonly selected option for surgical treatment. Your doctor will make a small cut over your elbow to do the work needed. The procedure is usually considered outpatient surgery, with no need to be hospitalized overnight.  The recovery is usually fast, and pain relief is noticible very quickly.

Arthroscopic Surgery

In arthroscopic surgery, your surgeon will make a tiny incision. They will then work inside your body using specialized, miniaturized instruments.

Surgical Risks and Rehabilitation

All surgeries involve risk, and your doctor will review these risks with you in advance to ensure you are a good candidate for the procedure. They will also help you choose the right kind of surgery for you.

Post-surgery you will have sutures and a splint for approximately one week. After that, you can expect approximately two months of very light physical therapy to help you recover. Between two and six months post-surgery, you may work up to more intensive therapy exercises as you regain full strength.


Maybe you are at high risk of developing tennis elbow or are already experiencing mild symptoms. If so, there are many things you can do to lower or risk or slow the progression of your condition.

Check Your Tools

Whether you play a sport or engage in repetitive motion at work, investing in the right tools can help. If you are an athlete or sportsman, have a professional assess your gear and techniques. Repair or replace gear that is not appropriately sized or specced to your needs and correct any techniques that you may be performing incorrectly.

In the workplace, explore opportunities for more ergonomic tools such as keyboards and mice, or look for ways to alter your working environment to reduce the strain on your hands, arms, and elbows.

If you are a hobbyist, invest in braces, compression sleeves, and other support tools.

Build Strength

Work with your doctor or therapist to identify and regularly practice exercises that can strengthen your hands, wrists, and arms. Ask them to show you new ways of moving that enable you to spread the strain across your shoulders and biceps to reduce the strain on your elbow and lower arms.


If possible, rotate between hobbies and stations at work. This variety will reduce the strain on your elbow and give it breaks to rest and heal after a period of strain.

Getting Help 

If you suspect that you may have lateral epicondylitis, don’t wait. Contact the tennis elbow experts for assessment and start getting the treatment you need today.

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The Hand Surgery Specialists of Texas offers diagnosis and treatment for hand, wrist, and elbow problems in Houston, using the most advanced and minimally invasive medical techniques. Our orthopedic hand specialists and hand and finger surgeons are waiting to provide you with excellent care at one of our hand care centers in River Oaks, Webster, North Houston, Katy/Sugarland, or Baytown

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