Tennis elbow

At a glance

  • Tennis elbow arises from irritation where the tendons attach to muscles on the outside of the elbow.
  • It hurts when you move the arm, and it’s hard to grasp objects.
  • It is usually caused by repetitive movements or too much strain, often during sports.
  • At first it’s a good idea to stop doing the things that are causing the symptoms.
  • After that, specific strengthening exercises can help.
  • Mostly you will need patience.


Photo of a woman at a cash register

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.


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 article

Painful 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.


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.


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.


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 . 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 () are only considered if doctors think that you might have something else.


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 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 . 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.

Ahmad Z, Siddiqui N, Malik SS et al. Lateral epicondylitis: a review of pathology and management. Bone Joint J 2013; 95-B(9): 1158-1164.

Bisset L, Coombes B, Vicenzino B. Tennis elbow. Clin Evid 2011.

Buchbinder R, Johnston RV, Barnsley L et al. Surgery for lateral elbow pain. Cochrane Database Syst Rev 2011; (3): CD003525.

Dingemanse R, Randsdorp M, Koes BW et al. Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: a systematic review. Br J Sports Med 2014; 48(12): 957-965.

Dong W, Goost H, Lin XB et al. Injection therapies for lateral epicondylalgia: a systematic review and Bayesian network meta-analysis. Br J Sports Med 2016; 50(15): 900-908.

Loew LM, Brosseau L, Tugwell P et al. Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis. Cochrane Database Syst Rev 2014; (11): CD003528.

Mattie R, Wong J, McCormick Z et al. Percutaneous Needle Tenotomy for the Treatment of Lateral Epicondylitis: A Systematic Review of the Literature. PM R 2017; 9(6): 603-611.

Orchard J, Kountouris A. The management of tennis elbow. BMJ 2011; 342: d2687.

Raman J, MacDermid JC, Grewal R. Effectiveness of different methods of resistance exercises in lateral epicondylosis - a systematic review. J Hand Ther 2012; 25(1): 5-25; quiz 26.

Tang H, Fan H, Chen J et al. Acupuncture for Lateral Epicondylitis: A Systematic Review. Evid Based Complement Alternat Med 2015: 861849.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Print page

Updated on July 15, 2022
Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.