Tennis elbow causes symptoms and treatment

Have you ever felt a sharp pain in your elbow after exercising or performing repetitive arm movements? This could be a sign of Tennis Elbow, a common condition that affects many people—whether they are professional athletes or recreational players.Although this injury is mainly associated with tennis, any activity that involves repetitive arm and wrist movements can lead to the same problem.In this Dalili Medical article, we will explore the causes of Tennis Elbow, the symptoms you should watch for, and the latest treatment options that can help you recover quickly and safely. Keep reading to discover how you can relieve the pain and restore your strength and mobility once again!

1️⃣ What Is Tennis Elbow?

Tennis Elbow, medically known as lateral epicondylitis, is an inflammatory condition that affects the tendons on the outer part of the elbow. It occurs as a result of overuse, repetitive movements, or excessive strain on the forearm muscles and tendons.

This injury commonly develops from activities that require repeated arm and wrist motions, such as tennis strokes, weightlifting, or repetitive gripping tasks.

2️⃣ Can I Exercise During Treatment?

It is important to avoid activities that increase pain or strain on the elbow until proper healing occurs. Continuing stressful movements may worsen the condition.

Once improvement is confirmed, you can gradually return to sports—typically after 4–6 weeks in mild cases. The timeline may vary depending on the severity of the injury.

3️⃣ Is Tennis Elbow Temporary or Chronic?

In many cases, Tennis Elbow is temporary if treated properly in its early stages.

However, if left untreated or improperly managed, it may become chronic, lasting for several months or even years.

4️⃣ Does Tennis Elbow Only Affect Athletes?

Despite the name, Tennis Elbow does not only affect athletes. It can develop in anyone who performs repetitive arm or wrist movements or places strain on the elbow tendons, including:

  • Workers who lift heavy objects or use hand tools

  • Individuals who use computers for long periods

  • Athletes in other sports involving repetitive arm movements

5️⃣ Can I Return to Work or Daily Activities After Treatment?

This depends on the severity of the condition.

  • In mild cases, patients may return to normal daily activities within a few weeks.

  • For sports or physically demanding tasks, gradual return is recommended after 4–6 weeks.

  • Heavy activities may require a longer recovery period depending on medical advice.

6️⃣ Can Medications Be Used Long-Term?

Medications such as pain relievers and anti-inflammatory drugs (NSAIDs) are typically used only for short-term relief of pain and inflammation.

Long-term use is not recommended due to potential side effects, including:

  • Stomach ulcers

  • Kidney problems

Long-term recovery is better supported by physical therapy and proper medical guidance.

7️⃣ Can Cortisone Injections Treat Tennis Elbow?

Yes, cortisone injections can provide rapid pain relief and reduce inflammation, especially in acute cases.

However, they should be used cautiously, as repeated injections may weaken the tendons over time.

Causes of Tennis Elbow

1️⃣ Repetitive Arm and Wrist Movements

  • Sports such as tennis or baseball that involve repetitive, forceful arm motions

  • Excessive weightlifting or intense training

  • Prolonged typing or computer use

2️⃣ Excessive Strain on the Wrist and Arm

  • Improper lifting techniques

  • Repeated twisting of the wrist

  • Strong gripping or continuous stretching movements

3️⃣ Improper Use of Sports Equipment

  • Heavy or unsuitable tennis rackets

  • Poor playing technique

  • Incorrect grip position

4️⃣ Aging

As we age, tendons become less flexible and more prone to injury.
Reduced healing capacity increases the risk of developing Tennis Elbow.

5️⃣ Occupational Stress

Repetitive work such as:

  • Carpentry

  • Farming

  • Typing

  • Manual labor

These activities can place continuous strain on the elbow tendons.

6️⃣ Previous Injury

A prior elbow or forearm injury may weaken the tendons, making them more vulnerable to inflammation.

7️⃣ Overtraining Without Rest

Excessive sports training without adequate rest periods increases tendon stress and injury risk.

8️⃣ Muscle Imbalance

Weak supporting muscles around the elbow and forearm can increase stress on the tendons, raising the likelihood of injury.

Symptoms of Tennis Elbow

1️⃣ Pain on the Outer Side of the Elbow

  • Persistent or intermittent pain around the lateral epicondyle (the bony bump on the outer elbow)

  • Pain worsens with repetitive movements

2️⃣ Increased Pain When Gripping or Lifting

  • Holding a racket or lifting heavy objects increases discomfort

  • Weak grip strength is a common sign

3️⃣ Pain with Wrist Extension or Twisting

Pain increases when extending the wrist upward or twisting it due to tendon involvement.

4️⃣ Mild Swelling or Redness

Some cases may show slight swelling, redness, or warmth around the elbow.

5️⃣ Stiffness in the Elbow

Difficulty moving the elbow freely, affecting daily activities.

6️⃣ Pain at Rest or During Sleep

In advanced cases, pain may persist even at rest and disturb sleep.

7️⃣ Muscle Weakness

Ongoing pain may lead to weakness in the forearm muscles, especially those controlling wrist and arm movement.

8️⃣ Pain During Repetitive Activities

Pain worsens during sports like tennis or baseball, as well as repetitive manual tasks or typing.

9️⃣ Chronic Tendon Inflammation (Tendinitis)

If the condition progresses, inflammation may lead to chronic tendon degeneration, increasing pain and limiting elbow mobility.

Types of Tennis Elbow

1️⃣ Lateral Epicondylitis

The most common type, commonly known as Tennis Elbow.

It occurs due to inflammation of the tendons on the outer part of the elbow as a result of repetitive strain.

It is frequently associated with sports that involve repeated arm movements such as tennis or baseball.

2️⃣ Medial Epicondylitis

Less common and sometimes referred to as Golfer’s Elbow.

It affects the inner part of the elbow and results from repetitive stress on the tendons.

Pain typically worsens when bending or twisting the wrist.

3️⃣ Chronic Lateral Tendinosis (Tennis Elbow Tendinosis)

A more severe condition caused by long-term tendon degeneration due to ongoing strain.

Symptoms may range from temporary sharp pain to persistent chronic discomfort.

In this stage, the tendons undergo degeneration rather than simple inflammation.

4️⃣ Partial Tendon Tear

Occurs when inflammation becomes severe and leads to a partial tear in the tendon.

Symptoms include sharp pain and difficulty with movement, especially when lifting objects or performing previously painful activities.

5️⃣ Tendon Inflammation Due to Elbow Joint Injury

A rare condition that develops as a result of direct elbow joint injury, causing pressure on surrounding tendons.

It is often associated with previous trauma leading to long-term inflammation.

Risks and Complications of Tennis Elbow

1️⃣ Development of Chronic Pain

If left untreated, acute pain may progress into persistent chronic pain.

This can interfere with daily activities such as lifting objects or typing.

2️⃣ Muscle Weakness

Ongoing pain and swelling can limit arm use.

This may lead to forearm muscle weakness, making wrist movement and lifting more difficult.

Weak muscles also increase the risk of future injuries.

3️⃣ Tendon Rupture

In advanced cases, partial or complete tendon rupture may occur.

A rupture can cause severe pain and may require surgical intervention.

Untreated ruptures can result in permanent tendon damage.

4️⃣ Difficulty Performing Daily Activities

As the condition progresses, routine tasks like writing, cooking, or lifting heavy objects may become painful and challenging, negatively affecting quality of life.

5️⃣ Reduced Athletic Performance

Athletes may need to temporarily or permanently stop sports such as tennis or baseball.

Persistent pain may prevent returning to previous performance levels.

6️⃣ Chronic Tendon Inflammation

Without proper treatment, inflammation may become chronic.

Tendons become weaker and more prone to reinjury, prolonging recovery time.

7️⃣ Increased Swelling

Uncontrolled swelling may limit normal elbow movement and increase pressure on nearby nerves.

8️⃣ Impact on Professional Life

Individuals who rely heavily on arm use for work—such as typing, manual labor, or sports—may experience negative career impacts due to pain and weakness.

9️⃣ Surgical Complications

In severe cases requiring surgery, potential complications may include:

  • Infection

  • Scar tissue formation

  • Joint stiffness

  • Nerve-related complications

Surgery is typically reserved for cases that do not respond to conservative treatment.

Diagnosis of Tennis Elbow

1️⃣ Medical History and Physical Examination

Medical History

The doctor will ask about:

  • When the pain started and how it progressed

  • Repetitive activities or sports involvement

  • Any previous elbow injuries

Physical Examination

  • Palpation of the outer elbow to locate pain

  • Muscle strength testing

  • Movement tests such as wrist extension or arm lifting

2️⃣ Special Clinical Tests

  • Cozen’s Test: Pain during resisted wrist extension suggests Tennis Elbow.

  • Mill’s Test: Pain when the wrist is flexed downward indicates tendon inflammation.

  • Maudsley’s Test: Pain when resisting extension of the fingers suggests tendon involvement.

3️⃣ Imaging Tests

X-ray

Used to rule out fractures or bone abnormalities. It does not directly show tendon inflammation.

MRI (Magnetic Resonance Imaging)

The most detailed imaging test. It can detect:

  • Tendon inflammation

  • Partial tears

  • Surrounding tissue damage

Ultrasound

Useful for visualizing tendon inflammation or tears and assessing surrounding soft tissue changes.

4️⃣ Nerve and Muscle Studies (EMG & NCS)

Used to determine whether the pain is related to nerve compression or neurological conditions.

5️⃣ Differential Diagnosis

Other conditions that must be ruled out include:

  • Other tendon injuries

  • Joint arthritis

  • Nerve entrapment syndromes

  • Soft tissue disorders

Non-Surgical Treatment of Tennis Elbow

1️⃣ Rest and Activity Modification

Avoid activities that worsen pain, such as tennis or heavy lifting.
Stop repetitive wrist and elbow movements that increase strain.

2️⃣ Ice and Heat Therapy

  • Ice: 15–20 minutes several times daily during the acute phase to reduce swelling.

  • Heat: After swelling subsides, heat may reduce stiffness and improve flexibility.

3️⃣ Medications

Pain Relievers

Ibuprofen or acetaminophen to reduce pain and inflammation.

Corticosteroid Injections

Used in acute or severe cases to reduce inflammation and pain.

4️⃣ Physical Therapy

  • Strengthening exercises for forearm muscles

  • Stretching exercises to improve flexibility

  • Range-of-motion exercises to reduce stiffness

5️⃣ Elbow Brace

Provides support and limits excessive movement during healing.
Especially helpful in acute cases.

Surgical Treatment of Tennis Elbow

Surgery is considered only if non-surgical treatment fails after 6–12 months.

1️⃣ Tendon Repair Surgery

Removal of damaged tissue and repair of the remaining tendon.
Goal: relieve pain and restore strength.

2️⃣ Tendon Release Surgery

Removal of fibrotic tissue causing pain and tension.

3️⃣ Tendon Debridement

Removal of inflamed or scarred tissue, often using arthroscopy.

4️⃣ Stem Cell Therapy

Uses stem cells from the patient’s body to promote tissue repair.
May be beneficial in chronic cases.

5️⃣ Arthroscopic Surgery

Minimally invasive procedure with smaller incisions.
Reduces pain and shortens recovery time compared to open surgery.

Recovery Time for Tennis Elbow

???? Without Surgery

Acute Stage (Early Diagnosis)

Recovery: 4–6 weeks
Includes rest, therapy, and anti-inflammatory medications.

Subacute Stage

Recovery: 1–3 months
Gradual restoration of strength and movement.

Chronic Stage

Recovery: 3–6 months or longer
May require ongoing therapy or injections.

???? After Surgery

  • Initial recovery: 6–12 weeks

  • Full recovery: 3–6 months, possibly longer in severe cases

  • Severe chronic cases: up to 6–12 months

Factors Affecting Recovery Time

  • Severity of the injury

  • Early medical intervention

  • Adherence to therapy and exercises

  • Presence of chronic diseases

Medical Treatment for Tennis Elbow

1️⃣ NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Purpose

Reduce inflammation and relieve pain.

Common Types

  • Ibuprofen

  • Diclofenac

  • Naproxen

Possible Side Effects

Stomach irritation, ulcers, kidney or heart issues with prolonged use.

2️⃣ Analgesics (Pain Relievers)

  • Acetaminophen (Paracetamol)

  • Tramadol (for severe pain, under supervision)

Excessive acetaminophen may affect the liver.
Tramadol may cause drowsiness or dizziness.

3️⃣ Corticosteroid Injections

Provide fast relief in severe or chronic cases.
However, repeated injections may weaken tendons.

4️⃣ Topical Medications

  • Diclofenac gel

  • Capsaicin cream

Applied directly to the affected area.
Possible mild skin irritation.

5️⃣ Nutritional Supplements

  • Collagen or gelatin to support tendon health

  • Vitamin C to enhance collagen production

6️⃣ Muscle Relaxants

  • Cyclobenzaprine

  • Baclofen

Used short-term for severe muscle tension.

7️⃣ Advanced Treatments

Platelet-Rich Plasma (PRP) Injections

PRP uses the patient’s own blood components to stimulate tendon healing and reduce inflammation.

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