Tennis Elbow (Lateral Epicondylitis)

What is tennis elbow?

Tennis elbow is a painful condition that develops from overusing the muscles and tendons (tissues connecting muscle to bone) in the elbow and forearm. Another name for this condition is lateral epicondylitis.

Tennis elbow usually occurs because of repetitive wrist and arm movements, and is common in people who play racket sports such as tennis and pickleball. Despite the name, tennis elbow can affect anyone who regularly swings or twists their forearm, such as painters, plumbers, and carpenters. Many people heal from tennis elbow on their own through nonsurgical treatment methods like rest or physical therapy.

At Mass General Brigham, we specialize in treating all hand, arm, and wrist injuries and conditions, including those that come from sports or an active lifestyle. We partner with you to create a clear, research-based treatment plan, so you understand your options and feel confident about your care.

Tennis elbow symptoms

The most common sign of tennis elbow is sharp outer elbow pain. The pain might worsen when you twist your wrist or forearm, such as when you open a jar or turn a doorknob. Other signs you might notice include:

• Elbow stiffness
• Pain that radiates down your forearm and wrist
• Swelling in your elbow or forearm
• Weakened grip

Causes of tennis elbow

Tennis elbow can develop when repetitive gripping or wrist movements strain the forearm muscles that stabilize the wrist. This overuse can cause tiny tears in the tendons where the muscles attach to the outer elbow.

Certain factors increase the risk of developing tennis elbow, including:

• Age: The condition is most common in people ages 30 to 60.
• Occupation: Jobs that involve repetitive wrist and forearm movements can increase the risk of tennis elbow. These professions include plumbing, painting, carpentry, cooking, and auto repair work.
• Sports: Playing sports that involve repetitive wrist extension and forearm muscle tension can lead to tennis elbow. These repetitive motions are common in racket sports, like tennis, pickleball, racquetball, ping pong, and badminton.

Diagnosing tennis elbow

Diagnosing tennis elbow starts with discussing your symptoms and health history with a medical professional. Your doctor may ask:

• When did you first notice symptoms?
• What symptoms bother you most?
• Does anything relieve or worsen symptoms?
• Do you play racket sports or have a job that involves significant wrist and forearm movement?

Following a conversation about your symptoms, your doctor will likely conduct a physical exam of your elbow and forearm. They may press on your elbow, or ask you to move your arm or grip something. They might order X-rays to get a closer look at the area.

Tennis elbow treatment

Most people with tennis elbow improve with time and non-surgical care. Early treatment focuses on reducing pain, allowing the tendon to recover, and gradually restoring strength and movement.

If symptoms persist or interfere with daily activities, a sports medicine or orthopedic specialist can recommend additional treatment options tailored to your needs.

Physical therapy for tennis elbow

Physical or occupational therapy is often the most effective treatment for tennis elbow. A therapist designs a program to:

• Stretch tight forearm muscles and tendons
• Strengthen the wrist and forearm safely
• Improve grip mechanics and movement patterns
• Reduce stress on the elbow during work or sports

Therapists may also recommend equipment adjustments, activity modifications, or bracing to help prevent further irritation while healing.

Injection treatments for tennis elbow

In some cases, your doctor may recommend an injection to help manage persistent pain.

Corticosteroid injections can temporarily reduce inflammation, which may help you participate in rehabilitation with less discomfort. Because repeated steroid injections may weaken tendon tissue, they are used selectively and typically combined with therapy.

Other biologic injections may be recommended by your doctor, depending on your condition and goals.

Nonsurgical procedures for tennis elbow

When symptoms do not improve with therapy alone, minimally invasive procedures may help stimulate tendon healing:

• Extracorporeal shock wave therapy: Uses targeted sound waves to stimulate blood flow and promote tissue repair in the injured tendon.
• Needle fenestration (percutaneous needling): An ultrasound-guided needle is guided into the injured tendon to trigger a healing response.
• Ultrasonic tenotomy: A minimally invasive procedure that uses ultrasound to guide a vibrating instrument to the injured tendon. This removes damaged tendon tissue, while preserving healthy tissue.

These procedures are typically performed without open surgery and require little downtime.

Tennis elbow surgery

In rare cases, surgery may be recommended if comprehensive nonsurgical treatments haven’t been effective. During surgery, the surgeon removes damaged tendon tissue and repairs or reattaches healthy tendon. Most procedures are performed using minimally invasive techniques and followed by rehabilitation to restore strength and function.

Tennis elbow prevention

Tennis elbow cannot always be prevented, but you can lower your risk by reducing repetitive strain on the forearm tendons and:

• Using appropriately fitted/sized sports equipment
• Using proper technique during sports or lifting
• Strengthening forearm and shoulder muscles
• Taking breaks during repetitive tasks
• Warming up before exercise and stretching afterward