Introduction

Photo of a woman at a cash register (PantherMedia / Wavebreakmedia ltd)

Tennis elbow (medical term: lateral epicondylitis) is usually caused by repetitive movements or too much strain – for instance, during sports like tennis or when doing manual labor. The main symptom is pain in the outer elbow, but it may also spread over the entire arm.

Tennis elbow typically requires a bit of patience: It often takes a few months for the symptoms to clear up. Certain treatments can relieve the pain somewhat or speed up recovery. But many of the treatments that are offered haven't been proven to work.

Symptoms

The pain in the outer elbow is mostly only felt when the elbow is moved or touched, and it may spread into the upper arm, forearm or the hand. Even the simplest movements can be painful, like unscrewing the cap of a bottle. If the symptoms are severe, just lifting up a cup of coffee can be a problem.

It also becomes difficult to get a strong grip, and the arm is often less flexible than it was before. The pain might go away when the arm is resting. These symptoms can also occur at night and make it hard to sleep, though.

Pain on the inside of the elbow could be a sign of a condition known as “golfer's elbow” instead. Treatment for golfer’s elbow is usually similar to that for tennis elbow.

 

Illustration: Painful area in tennis elbow – as described in the articlePainful area in tennis elbow

Causes and risk factors

In tennis elbow, the pain arises where the tendons attach to muscles on the outside of the elbow. These tendons are involved in movements that extend the wrist. For this reason, hand and arm movements that put a strain on them – such as bending, stretching, twisting, grasping and lifting – can lead to the typical symptoms.

It often affects people who usually don’t use their forearm muscles much, and then suddenly overuse them. But the symptoms don’t only result from short-term overuse. Regular repetitive strain can also result in tennis elbow. Possible causes include:

  • Sports like tennis, rowing or strength training
  • Manual labor like painting, carpentry or turning screws
  • Heavy lifting
  • Playing musical instruments, such as the piano
  • Working at a computer or a supermarket cash register

So although tennis elbow can actually be caused by playing tennis, it usually has nothing to do with this sport.

Doctors used to think that the pain was caused by an inflammation in the muscles. But this was not found to be the case. Nowadays it's thought that something else plays an important role: Tennis elbow probably arises from the overuse or incorrect use of muscles, which leads to small injuries and wear and tear at the base of the tendons that attach to the muscles But it’s not really known what exactly causes tennis elbow.

Prevalence

About 2% of the population have tennis elbow. The symptoms are most common in people between the ages of 40 and 60 – probably because the muscles are more susceptible to overuse in middle and older age. Tennis elbow is equally common in men and women.

Outlook

Sometimes the symptoms go away after just a few weeks, but they often last several months. In about 80% of people who develop tennis elbow, the pain goes away within one year. The others continue to have symptoms for longer.

Diagnosis

The doctor will first ask you what sort of activities make the pain noticeable and whether you have any other medical conditions. Then they will examine your arm and check what movements trigger the pain. This might involve extending your arm with the palm of your hand facing down, and then pressing the same hand upwards against a certain amount of resistance. If that makes your elbow hurt, it’s a sign of tennis elbow.

A physical examination is usually enough to find out whether you have tennis elbow. X-rays, ultrasound scans or MRI (magnetic resonance imaging) are only considered if doctors think that you might have something else.

Treatment

The goal of treatment is to relieve the pain and to improve the mobility and strength of the arm and wrist.

Trying to avoid activities that provoke the symptoms – or reducing those activities enough to make the symptoms improve – may already help. Special exercises to strengthen the forearm and wrist, called “eccentric exercises,” can help to relieve the pain. Manual therapy by a physiotherapist can help too.

Doctors often use very different approaches to treat tennis elbow. But only a few of these treatments have been proven to be able to relieve the symptoms. First and foremost, tennis elbow requires patience. The symptoms usually clear up after a few months without any special treatment.

Non-steroidal anti-inflammatory drugs (NSAIDs) can provide short-term relief. Steroid injections can also relieve pain, but they may disrupt the healing process. A few studies suggest that ultrasound therapy can somewhat improve the pain.

There is no proof that the following treatments help, though: various injection treatments (for example with blood taken from your own body or Botox), laser therapy, electrotherapy, massage, shockwave therapy and acupuncture. German statutory health insurers often don't cover the costs of these treatments.

If the symptoms continue for a long time and other treatments don’t help, surgery is sometimes suggested. There has hardly been any research on tennis elbow surgery, though.

Learn more

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.