Tennis Elbow (Lateral Epicondylitis)

Tennis elbow (the clinical name is lateral epicondylitis, though that is a bit of a misnomer) is a painful overuse condition of the tendons that anchor your wrist-extensor muscles to the bony bump on the outside of your elbow, a prominence called the lateral epicondyle. Despite the name, only about 5% of cases happen in tennis players. It is far more common in people aged 35 to 55 who do repetitive gripping or twisting motions at work or at home: carpenters, painters, plumbers, butchers, and a lot of computer workers whose forearm muscles are loaded the same way for hours each day.

The underlying issue is not active inflammation (which is what the "-itis" suffix implies) but rather tendon degeneration: the fibers that give the tendon its strength have partially broken down and lost their normal, orderly structure. This process is called tendinosis, and it explains why rest alone rarely fixes the problem and why anti-inflammatory treatments only help temporarily. The tendon needs graduated loading to signal it to remodel the damaged collagen back into organized tissue.

The condition typically develops gradually over weeks and is usually well along before people seek care. It can affect both elbows but most commonly hits the dominant arm. With the right rehab approach, more than 90% of patients recover without surgery, though it can take several months of consistent effort.

The signature symptom is pain on the bony bump on the outside of your elbow, especially when you grip, twist a doorknob, shake hands, or lift something with your palm facing down. The pain often radiates into the forearm. You may notice your grip weakening: dropping a coffee mug or struggling to open a jar are common early complaints.

Symptoms typically come on gradually over weeks and worsen with repetitive arm use. The outer elbow is tender to press, and the pain flares when you extend your wrist against resistance. Morning stiffness at the elbow is common, and the pain may wake you at night if you sleep with the arm bent and pressed against the mattress.

Tennis elbow is usually a clinical diagnosis, meaning the history and a focused physical exam of the elbow are enough. The signature finding is pain on the outside of the elbow, right where the tendon attaches to the bony bump, made worse by gripping (especially with the arm straight) or by resisting while the wrist is extended. X-rays are usually normal and are not needed in a typical case. When imaging is ordered, ultrasound and MRI show the thickened, degenerated tendon.

Because tennis elbow is tendon degeneration rather than active inflammation, rest alone rarely fixes it and anti-inflammatory treatments only help temporarily. The tendon needs graduated loading to signal it to remodel the damaged collagen back into organized tissue. The treatments below are listed in the order they are usually introduced, and each is added on top of the ones before, not instead of them. More than 90% of patients recover with this non-operative approach, though it can take several months of consistent effort.

First-Line Care

If Symptoms Persist

When the first-line steps have not settled the pain, these are added in turn:

1. NSAIDs / Topical Diclofenac

   Oral or topical anti-inflammatory medication for short-term symptom relief during a flare.

2. Corticosteroid Injection

   A cortisone shot gives fast short-term pain relief, but it does not change the long-term course and may even slow tendon healing; used sparingly when other steps have not worked.

3. PRP Injection

   A PRP (platelet-rich plasma) injection: concentrated growth factors taken from your own blood and injected into the degenerated tendon. It is sometimes considered after rest, activity changes, bracing, physical therapy, NSAIDs, and a corticosteroid injection have not helped. Evidence is mixed and still being studied. It is not covered by insurance (self-pay).

Surgery is reserved for the small minority of patients (under 5%) with persistent, disabling symptoms after a real trial of non-operative care including PRP. The procedure cleans out the degenerated portion of the tendon.

External patient-education references and related OSI pages for additional background:

• AAOS OrthoInfo, patient education library
• OSI glossary, orthopedic terminology in plain language