Tennis Elbow: Causes, Symptoms, and Effective Treatment Strategies

Tennis elbow is badly named. Most people who get it have never held a racquet. It turns up in builders, office workers, gardeners and parents carrying car seats, usually between the ages of 35 and 55, as pain on the outside of the elbow when gripping, lifting or turning a door handle.

Its medical name is lateral epicondylitis, though lateral elbow tendinopathy is more accurate, because the problem is mostly an overloaded tendon and only partly inflammation. The tennis and golfer’s elbow guide covers the evidence for each treatment in detail.

What causes it?

The muscles that lift the wrist and fingers attach by a shared tendon to a bony point on the outside of the elbow, the lateral epicondyle. Repeated gripping and wrist movements, particularly a sudden increase in them, can overload that tendon. The tendon tissue changes and becomes painful and less able to cope with load.

What does it feel like?

Pain or burning on the outside of the elbow usually comes on gradually. It can spread down the forearm and is worse when gripping, lifting with the palm facing down, or twisting. Grip often feels weaker.

How is it treated?

Most tennis elbow improves without injections or surgery, though it can take months. The usual approach is to reduce the most aggravating gripping and lifting for a while, without resting the arm completely, and to start a strengthening programme for the forearm muscles that is built up gradually. A forearm strap helps some people.

Cortisone injections give short-term relief but tend to backfire. In a well-known Australian trial by Coombes and colleagues, people who had a cortisone injection did worse at one year than those given a placebo injection. Surgery is kept for the few with severe pain that persists after a year or more of good treatment.

Where do prolotherapy and PRP fit?

For tennis elbow that persists despite a good strengthening programme, PRP and prolotherapy are sometimes considered. PRP has more trial evidence in tennis elbow than in most other conditions, though the results are mixed. Neither is a guaranteed cure, and both are used alongside the exercise programme. Suitability depends on the diagnosis, what has been tried, the cost and the alternatives.

Can it be prevented?

Good technique, the right grip size on tools and racquets, and building up gradually when starting a new job or activity all reduce the load on the tendon. Keeping the forearm muscles strong helps prevent it coming back.

How long will it last?

For most people, the pain settles over several months with the right exercise and load changes. The elbow usually recovers, and patience with the strengthening programme is what gets it there.