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Elbow pain?

Tennis Elbow Image Copyrighted c2018 Sagar Parikh MD

Tennis elbow — It’s NOT just for tennis players! Do you feel pain in your elbow or forearm, and this pain feels worse when holding your morning coffee or opening a door? If so, there is a chance you have tennis elbow.

In medical terms, tennis elbow, is known as lateral epicondylitis or even epicondylosis depending on how technical you want to get. It’s a musculoskeletal condition that occurs when tendons in your elbow and also attached to the muscles extending from your wrist are overused by repetitive wrist and arm motions. It's a classic repetitive strain injury ( RSI) and often referred to as tennis elbow because tennis players are more prone to this condition when repeatedly performing certain swings. Playing tennis or other racquet sports can cause this condition, but it does not mean that this is the only sport or activity that puts you at risk.

The muscles found on the back part of the forearm (the ones that extend your wrist) are attached via tendons to the boney prominence of the elbow — the lateral epicondyle. When the repetitive movement is performed, the tendon of the wrist extensor muscles can get in contact with this bony prominence and cause friction, micro-tears, and inflammation. When left untreated, the condition worsens and diminishes the functions of the affected upper extremity, making you feel as if you are losing strength.


Athletes are not the only ones who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle.

Even an activity such as wringing wet clothes too hard or using a hammer repetitively on a regular basis may cause the condition. Studies have shown that carpenters, plumbers, auto workers, cooks, painters, musicians and even butchers are more likely prone to getting tennis elbow than others because of the way the workers carry out activities such as gripping, twisting, reaching, and moving. These activities can become hazardous when they are performed:

  • in fixed or awkward position

  • with constant repetition

  • with excessive force, and

  • without allowing the body to recover from the wear and tear

In general, the repetitive and forceful motion and weight lifting required for these activities leads to the injury. However, there are some cases when lateral epicondylitis occurs without any recognized repetitive injury.


The symptoms of tennis elbow usually develop gradually. People may experience it initially as mild pain on the outer part of the elbow that is usually characterized as dull and aching. As weeks and months pass by, the pain begins to intensify. In some instances, the person’s daily routine is affected because of the pain.

Pain areas: in the elbow or forearm muscles

Also common: swelling or tenderness

Other symptoms that accompany this condition include:

  • Pain or burning on the outer part of your elbow

  • Weak hand grip

  • Tenderness

  • Swelling

Tenderness and swelling is usually because of the recurring inflammation that takes place on the affected part. Pain on the region is usually the cause of weak hand grip due to muscle guarding, a coping mechanism to minimize the pain on the outer part of the elbow.


Tennis elbow is usually self-diagnosable, however it's also a common reason why people see their doctors. Identifying the probable cause of the condition may be easily overlooked when figuring it out and therefore consulting a doctor is important for diagnosis and treatment.

Your doctor will consider many factors in making a diagnosis. This includes examining the affected area, how your symptoms developed, occupational risk factors, recreational sport activity, medical history (i.e. rheumatoid arthritis or nerve disease) and performing tests. Be sure to tell your doctor if you have ever injured your elbow

Majority of people (80-90%) with tennis elbow can be treated without resorting to surgery. In this case, physical therapy and using a temporary brace is the recommended intervention of choice. The following are some other recommended treatment methods:

  • Rest - Initially resting the affected part reduces further friction from taking place.

  • Heat or Ice – If there is initial acute swelling noted on the side of your elbow, ice may provide some relief. For long-term care, consider using heat to promote blood circulation to a chronically injured tendon or muscle.

  • Lifestyle modification – A thoughtful physician will be able to start the discussion on how to reduce further injury and pain. He/she may ask you to examine your equipment for proper fit (i.e. tennis racket) or refer you to a physical therapist. In the physical therapy sessions, you would be taught concepts such as proper movement to help prevent the recurrence of the condition.

  • Anti-inflammatory medicines - NSAIDs like aspirin and ibuprofen can counteract inflammation and offer pain relief.

  • Bracing helps immobilize the affected forearm to further prevent injury on the area (Look for a “Tennis Elbow Strap”)

  • New developments in the field of Regenerative Medicine have shown that platelet-rich-plasma (PRP) injections may help regenerate injured tissue. A published study concludes clinically meaningful improvements were found in patients treated with PRP. (Be sure to find a qualified physician that uses ultrasound-guidance to precisely administer this injection).


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