Tennis Elbow: Symptoms, Types, Causes and Treatment

Tennis elbow is a condition that affects countless people—not just tennis players. Whether you’re an athlete, a manual laborer, or simply someone who loves gardening or typing, you could be at risk for this common yet often misunderstood ailment. In this comprehensive article, we’ll explore the symptoms, types, causes, and treatment options for tennis elbow, using the latest research and clinical evidence to provide you with clear, actionable information.

Symptoms of Tennis Elbow

Tennis elbow doesn’t suddenly announce itself; rather, it creeps up with subtle signs that can easily be mistaken for minor overuse or even ignored as everyday aches. Recognizing the symptoms early can help you seek appropriate care and prevent long-term discomfort.

Symptom	Description	Commonality	Source(s)
Lateral pain	Pain on the outer side of the elbow	Very common	1 2 4 5 9
Activity pain	Pain worsens with wrist or finger extension	Very common	1 2 4 5 9
Tenderness	Tenderness at lateral epicondyle	Hallmark finding	1 2 5 9
Weak grip	Reduced strength when gripping objects	Frequent	2 5
Radiating pain	Discomfort may radiate down forearm	Sometimes	4 9
Normal motion	Elbow range of motion usually preserved	Typical	1 2 7

Table 1: Key Symptoms

Understanding the Symptoms

Lateral Elbow Pain

The most notable symptom is pain on the outer (lateral) part of the elbow. This discomfort is usually gradual in onset, not linked to a single traumatic event. It often starts as a mild ache and can intensify with use of the arm, especially during activities that require wrist extension—like pouring a kettle or shaking hands 1 2 4 5 9.

Pain Triggered by Activity

Movements that especially provoke pain include extending the wrist, gripping, or lifting objects, particularly with the palm facing downward. Even simple daily tasks, such as turning a doorknob or holding a coffee mug, can become painful 1 2 4 5 9.

Tenderness and Weak Grip

Palpating the bony bump on the outer side of the elbow—the lateral epicondyle—will often elicit tenderness. Many people also notice that their grip strength is reduced, making it difficult to hold onto objects firmly 2 5.

Radiating Pain and Normal Motion

The pain can sometimes radiate down the back of the forearm, but the elbow’s range of motion usually remains normal. If the elbow becomes stiff or cannot fully bend or straighten, another diagnosis should be considered 1 2 4 7.

Types of Tennis Elbow

Not all tennis elbow cases are the same. The term “tennis elbow” is often used to describe pain on the outside of the elbow, but it can originate from different underlying problems. Understanding these types helps in choosing the best treatment and avoiding misdiagnosis.

Type	Key Feature	Prevalence	Source(s)
Classic (tendinopathy)	Degenerative changes at tendon origin	Most common	1 2 5 7
Acute (traumatic)	Sudden onset after direct injury	Less common	9 10
Chronic	Persistent symptoms over months/years	Occasional	3 7 8
Mixed/Complex	Coexists with nerve entrapment or plica	Not uncommon	8

Table 2: Types of Tennis Elbow

Exploring the Types

Classic Tendinopathy

The majority of cases are due to a degenerative process at the origin of the extensor carpi radialis brevis tendon. This is not an inflammatory process (as previously thought), but rather a wear-and-tear phenomenon involving microtears and degeneration at the tendon’s attachment to the elbow 1 2 5 7.

Acute and Chronic Forms

Tennis elbow can appear suddenly after a specific injury (acute), but more often, it develops over time due to repetitive stress (chronic). Chronic cases can be stubborn and last many months, sometimes persisting for more than a year 3 7 9 10.

Mixed or Complex Cases

Some people experience persistent symptoms because more than one problem is occurring at the same time. For example, tennis elbow pain can coexist with nerve entrapment (posterior interosseous nerve syndrome) or a thickened plica (a fold in the elbow joint lining), complicating both diagnosis and treatment 8. This highlights the importance of a thorough evaluation if symptoms linger.

Causes of Tennis Elbow

Tennis elbow is famously misnamed—most people who get it have never picked up a racquet. The “cause” actually refers to a spectrum of contributing factors, some occupational, some recreational, and some simply due to the wear-and-tear of life.

Cause	Description	Relative Frequency	Source(s)
Overuse/repetition	Repeated wrist/finger extension, gripping	Most common	1 2 5 6 9
Occupational	Manual labor, tool use, repetitive tasks	Very common	6 9
Sports-related	Tennis, racquet sports, poor technique	Notable	5 6 9 11
Traumatic injury	Direct blow or acute overstretch	Less common	9 10 11
Age-related	Increased incidence in ages 40–60	Significant	4 6 11
Unknown	No clear cause identified	Not rare	6

Table 3: Main Causes

Breaking Down the Causes

Repetitive Strain and Overuse

Most cases of tennis elbow arise from repetitive activities—often involving extension of the wrist or fingers against resistance. This could include playing tennis, but more commonly it’s seen in carpenters, plumbers, typists, or anyone who frequently grips or lifts objects 1 2 5 6 9.

Occupational and Recreational Factors

A significant proportion of cases are linked to occupational tasks involving heavy or repetitive use of the forearm muscles. Sports, especially those with poor technique or improper equipment, are another known risk factor, but account for fewer cases than commonly believed 5 6 9 11.

Age and Other Contributors

Tennis elbow is most common in middle age (ages 40–60), possibly due to age-related changes in tendon structure. Sometimes, a single direct blow or acute overstretching can trigger symptoms, though this is less typical 4 6 9 10 11.

Unexplained Cases

Notably, a sizeable number of people develop tennis elbow with no obvious cause, underscoring the role of individual susceptibility and perhaps subtle, cumulative microtrauma 6.

Treatment of Tennis Elbow

Most people with tennis elbow improve dramatically with simple, non-surgical treatments. Only a small minority require surgery or advanced interventions. Evidence-based care focuses on relieving pain, restoring function, and preventing recurrence.

Treatment Type	Main Approach/Benefits	Limitations/Risks	Source(s)
Rest & activity mod.	Reduces strain, allows healing	May take weeks/months	1 2 7 11 13
Physical therapy	Strengthening, flexibility, rehab	Requires commitment	11 13 14
Bracing/splinting	Offloads tendon, reduces pain	Temporary measure	10 13
Medications	NSAIDs for pain, short-term relief	Limited for chronic cases	11 13
Injections (steroids)	Rapid pain relief in some cases	Not for long-term use	11 13 14
Electrophysiotherapy	Pain/function improvement	Some risk of adverse effects	14
ESWT	Can relieve pain, improve grip	More studies needed	12
Surgery	Reserved for severe, refractory cases	Not always superior to others	2 7 10 11
Watchful waiting	High rate of spontaneous recovery	Patience required	3 7

Table 4: Primary Treatments

Non-Surgical Treatments

Rest and Activity Modification

The foundation of treatment is reducing or modifying whatever activities are causing pain. This doesn’t mean complete immobilization, but rather avoiding painful motions and allowing the tissues to heal 1 2 7 11 13. For many, this is enough.

Physical Therapy

A structured rehabilitation program is key. This includes:

• Stretching and strengthening exercises for the forearm muscles
• Techniques for gradually returning to activity
• Ergonomic adjustments (like changing racquet grip or workstation setup) 11 13 14

Therapy is most effective when tailored to the individual and introduced early.

Bracing and Splinting

A counterforce brace or wrist splint can temporarily reduce the load on the affected tendon, making daily activities more comfortable. These are most useful in the early phases or during flare-ups 10 13.

Medications and Injections

Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain, especially initially 11 13. Corticosteroid injections can provide rapid relief but are not recommended repeatedly due to potential adverse effects and lack of long-term benefit 11 13 14.

Electrophysiotherapy and Shock Wave Therapy

Electrophysiotherapy (including ultrasound, galvanic stimulation) has shown effectiveness in improving pain and function, though some adverse effects have been reported 14. Extracorporeal shock wave therapy (ESWT) is a newer noninvasive option with promising results for pain relief and grip strength, though more high-quality research is needed 12.

Watchful Waiting

Many cases improve without any active treatment—about 90% of people with tennis elbow recover within one year even with minimal intervention 3 7. This supports a conservative approach, especially for new or mild cases.

Surgical and Advanced Interventions

Surgery is rarely needed, reserved for patients who have not improved after prolonged non-surgical management. Procedures typically involve releasing the affected tendon’s attachment, with various techniques available 2 7 10 11. Outcomes are generally good, but not always superior to conservative care.

Preventing Recurrence

Once symptoms subside, attention should focus on:

• Proper technique (in sports and work)
• Equipment adjustments (racquet grip, tool handles)
• Regular strengthening and stretching 11 13

Holistic management, considering occupational and psychological factors, can further reduce the risk of recurrence 11.

Conclusion

Tennis elbow is a common, often self-limiting condition that can affect anyone—not just athletes. Early recognition, appropriate conservative management, and gradual rehabilitation are the cornerstones of care. Surgery is rarely needed, and most patients will recover fully with time and patience.

Key Takeaways:

• Tennis elbow most often presents as pain on the outer side of the elbow, worsened by wrist or finger extension.
• It’s primarily a degenerative (not inflammatory) tendon problem, commonly from overuse but also seen in manual laborers and middle-aged adults.
• Several types exist, including classic, acute, chronic, and mixed forms with nerve involvement.
• Most cases resolve with rest, activity modification, and physical therapy; advanced treatments are reserved for the minority with persistent symptoms.
• The majority of patients recover within a year, even without aggressive intervention.

Empowering yourself with knowledge and seeking early, evidence-based care can make all the difference in overcoming tennis elbow and returning to the activities you love.