Inflammation of the tendons on the outer elbow due to overuse.
Tennis elbow, medically known as lateral epicondylitis, is one of the most common causes of elbow pain. It affects the tendons that attach to the lateral epicondyle, the bony bump on the outer side of the elbow, and control extension of the wrist and fingers. These tendons are loaded constantly through daily life, from gripping a mug to typing, which is why the condition is common well beyond tennis players.
The underlying process is a tendinopathy: repeated small strain that outpaces the tendon's ability to repair itself, rather than a single acute injury or true inflammation in most established cases. This is one reason recovery tends to be gradual rather than immediate, and why load management is central to treatment.
Tennis elbow is caused by overload of the tendons that extend the wrist and fingers, where they attach at the lateral epicondyle. Despite the name, it is far more often related to work and everyday activity than to sport: repetitive gripping, lifting, and use of tools or a keyboard and mouse are common contributors. Trades such as painting, plumbing and carpentry are particularly associated with it.
In racquet sports, it is typically linked to technique, such as a mistimed or overly tight one-handed backhand, or to a sudden increase in playing frequency or intensity. It becomes more common from the fourth decade of life onward, and tendons that are already under strain from other activities are more vulnerable to developing symptoms.
Typical symptoms of tennis elbow include:
Symptoms typically build gradually rather than appearing suddenly, and often flare with a specific repetitive activity before settling somewhat with rest.
Diagnosis is usually made clinically, based on the pattern of pain and examination findings, without the need for imaging in most cases. An ultrasound or MRI scan may be used if symptoms are atypical or not responding to treatment as expected.
Non-surgical treatment is effective for the great majority of patients. This centres on activity modification to reduce the aggravating load, physiotherapy with an emphasis on eccentric strengthening exercises, and a counterforce brace to offload the tendon during activity. Simple pain relief or anti-inflammatory medication can help in the short term.
A corticosteroid injection may provide short-term relief in some patients, though the benefit is not always long-lasting. Extracorporeal shockwave therapy is sometimes used for persistent symptoms that have not responded to initial treatment.
Surgery, tennis elbow release, is reserved for the minority of patients whose symptoms remain significant after a genuine course of non-surgical treatment, usually of six months or more. It involves removing degenerated tendon tissue and, where required, reattaching healthy tendon to the bone.
Most people with tennis elbow recover well, though it can be a slow process; symptoms often take several months to settle fully, even with the right treatment, because tendon healing is gradual. The majority of cases resolve with non-surgical treatment alone.
Where surgery is required, outcomes are generally good, with most patients experiencing significant pain relief and a return to normal grip strength and function, though recovery again takes time and follows a structured rehabilitation programme.
Tennis elbow is common, very treatable, and affects far more people who have never played tennis than those who have. The great majority of cases improve with activity modification, physiotherapy and time, and surgery is reserved for the minority that do not settle. Persistent outer elbow pain, particularly if it is affecting grip or work, is worth having assessed.
