Tennis Elbow
What Is Tennis Elbow? Symptoms, Nerve Involvement, and Treatment Options
Tennis elbow, or lateral epicondylalgia or lateral epicondylitis, is a common condition that causes pain on the outside of the elbow. It’s typically the result of overuse or repetitive strain on the forearm muscles and tendons, particularly those involved in wrist extension and gripping. Despite the name, tennis elbow affects far more than just tennis players—it’s common among tradespeople, office workers, and anyone performing repetitive arm movements.
What Causes Tennis Elbow?
Tennis elbow is primarily caused by microtears and degeneration in the extensor carpi radialis brevis (ECRB) tendon, which attaches to the lateral epicondyle of the humerus. Repetitive wrist and forearm movements—such as lifting, gripping, or typing—can overload this tendon, leading to pain and dysfunction.
Can the Radial Nerve Be Involved?
Yes. In some cases, symptoms of tennis elbow may be complicated by radial nerve irritation or entrapment. The radial nerve runs near the lateral elbow and can become sensitized or compressed, especially in chronic or severe cases. This may lead to:
• Pain radiating down the forearm
• Numbness or tingling in the hand or fingers
• Increased sensitivity to touch or movement
• Weakness in grip strength
A thorough physical assessment can help differentiate between tendon-related pain and nerve involvement
Typical Symptoms of Tennis Elbow
While the hallmark symptom of tennis elbow is pain on the outside of the elbow, patients may also experience:
• Pain that radiates down the forearm toward the wrist
• Weak grip strength, especially when shaking hands or holding objects
• Stiffness in the elbow, particularly in the morning
• Pain when lifting, gripping, or twisting (e.g., turning a doorknob or opening a jar or picking up a coffee cup)
• Tenderness over the lateral epicondyle (bony bump on the outer elbow)
• Increased pain with wrist extension or resisted finger extension
• Discomfort when typing, using tools, or repetitive hand motions
• Burning sensation around the elbow area
• Pain that worsens with activity and improves with rest
• Possible tingling or numbness in the forearm or hand if the radial nerve is involved
These symptoms can vary in intensity and may develop gradually or suddenly, depending on the cause and severity of the condition.
Treatment Options for Tennis Elbow
Treatment is most effective when tailored to the individual’s symptoms, activity level, and whether nerve involvement is present. A combination of conservative and advanced therapies may be used.
1. Dry Needling
Involves inserting fine needles into the affected tendon or surrounding muscles to stimulate healing and reduce pain. Particularly useful in chronic cases [1].
2. Soft Tissue Therapy
Manual techniques such as deep tissue massage, myofascial release, and cross-friction massage help reduce muscle tension and improve circulation.
3. Stretching
Targeted stretching of the wrist extensors and forearm muscles helps reduce tension on the tendon and improve flexibility.
4. Nerve Mobilisation
If radial nerve involvement is suspected, nerve gliding or mobilisation exercises can help restore normal nerve movement and reduce sensitivity.
5. Taping
Kinesiology or rigid taping techniques can offload the affected tendon, reduce pain, and support functional movement during activity.
6. Strengthening Exercises
Progressive loading of the forearm muscles is essential for long-term recovery. This includes:
• Isometric exercises in early stages
• Eccentric loading of the wrist extensors
• Functional strengthening to restore grip and lifting capacity
7. Advanced Interventions
For persistent or severe cases, referral to a medical specialist may be appropriate for:
• Platelet-Rich Plasma (PRP) Injections: Uses the patient’s own blood components to promote tendon healing.
• Shockwave Therapy: Delivers acoustic waves to the affected area to reduce pain and stimulate tissue repair [1].
When to Seek Help
If elbow pain persists for more than a few weeks or interferes with daily activities, it’s important to seek professional assessment. Early intervention can prevent the condition from becoming chronic and reduce the risk of nerve involvement.
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Frequently Asked Questions (FAQs) About Tennis Elbow
1. Do I need to play tennis to get tennis elbow?
No. Despite the name, tennis elbow is not limited to tennis players. It can affect anyone who performs repetitive wrist or forearm movements—such as tradespeople, office workers, or gym-goers.
2. How do I know if the radial nerve is involved?
If your symptoms include tingling, numbness, or pain that radiates down the forearm or into the hand, the radial nerve may be irritated. Our therapists can assess this through specific clinical tests.
3. How long does it take to recover from tennis elbow?
Recovery time varies. Mild cases may improve within a few weeks, while chronic cases can take several months. Consistent treatment and adherence to a rehabilitation program are key to recovery.
4. Is dry needling painful?
Dry needling may cause a brief twitch or ache during treatment, but patients tolerate it well. It’s often used to reduce muscle tension, reduce trigger point pain and promote healing in chronic cases.
5. Can I still work or exercise with tennis elbow?
Yes, but you may need to modify your activities to avoid aggravating the condition. Your therapist can guide you on safe ways to stay active while protecting your elbow. There are tennis elbow braces that reduce the load on the lateral elbow that can reduce symptoms during activity
6. What if conservative treatment doesn’t work?
If symptoms persist after several months of conservative care, your therapist or GP may refer you for advanced treatments such as:
• Platelet-Rich Plasma (PRP) injections
• Shockwave therapy
These options aim to stimulate healing in stubborn or degenerative tendon tissue.
7. Will I need surgery?
Surgery is rarely required for tennis elbow. It’s typically considered only after 6–12 months of unsuccessful conservative treatment
8. Can tennis elbow go away on its own?
Mild cases may improve with rest and activity modification. However, without proper treatment—especially in chronic or repetitive cases—symptoms can persist or worsen over time. Early intervention with physical therapy is often more effective.
9. Is imaging (like an MRI or ultrasound) needed to diagnose tennis elbow?
In most cases, tennis elbow is diagnosed through a physical examination and patient history. Imaging may be used if symptoms are severe, persistent, or if another condition (like nerve entrapment or arthritis) is suspected.
10. What’s the difference between tennis elbow and golfer’s elbow?
Tennis elbow affects the outside of the elbow (lateral epicondyle), while golfer’s elbow affects the inside (medial epicondyle). Both are caused by overuse but involve different tendons and muscle groups.
11. Can I prevent tennis elbow from coming back?
Yes. Prevention strategies include:
• Strengthening forearm muscles
• Improving ergonomics at work or during sport
• Using proper technique and equipment
• Taking regular breaks from repetitive tasks
12. Is cortisone injection a good option?
Corticosteroid injections may provide short-term relief, but studies show they may not be effective long-term and could delay tendon healing. They are typically reserved for severe or persistent cases under medical supervision.
13. What is PRP and how does it help?
Platelet-Rich Plasma (PRP) therapy involves injecting a concentration of your own platelets into the affected tendon to promote healing. It’s considered for chronic cases that haven’t responded to conservative treatment.
14. How does shockwave therapy work?
Shockwave therapy uses acoustic waves to stimulate blood flow and tissue regeneration in the affected tendon. It’s often used for chronic or treatment-resistant cases and may reduce pain and improve function over time.
15. What age group is most affected by tennis elbow?
Tennis elbow most commonly affects adults between the ages of 40 and 60, but it can occur at any age, especially in individuals who perform repetitive arm and wrist movements
16. Is tennis elbow the same as tendinitis?
Not exactly. While tennis elbow was once thought to be caused by inflammation (tendinitis), research now shows it’s more often a degenerative condition called tendinosis, where the tendon tissue breaks down over time
17. Can tennis elbow affect both arms?
Yes, although it usually affects the dominant arm, it can occur in both arms, especially in people with jobs or hobbies that involve repetitive bilateral arm use.
18. How is tennis elbow diagnosed?
Diagnosis is typically made through a physical examination and patient history. In persistent or unclear cases, imaging such as ultrasound or MRI may be used to assess tendon damage or rule out other conditions
19. Can I use a brace or strap for tennis elbow?
Yes. A counterforce brace or forearm strap can help reduce strain on the tendon during activity and may relieve symptoms during the healing process.
20. What happens if tennis elbow is left untreated?
Without treatment, symptoms may persist or worsen. Chronic cases can lead to tendon degeneration, reduced grip strength, and long-term discomfort. Early intervention improves outcomes
21. Can sleeping positions affect tennis elbow?
Yes. Sleeping with your arm bent or under your head can increase pressure on the elbow. Using a pillow to support the arm and keeping the elbow in a neutral position may help reduce nighttime discomfort.