Tennis elbow: causes, symptoms and treatment

What is tennis elbow?

Tennis elbow, or lateral epicondylitis, is a tendon injury on the outside of the elbow. Its main symptoms are pain in the elbow and forearm. It is usually caused by repeated motions, from tennis and weightlifting to painting, typing, knitting and woodwork. The pain tends to get worse when you lift, grip, twist or bend the wrist back. Common treatments include physical therapy, anti-inflammatory medications (NSAIDs), ice, bracing and steroid injections. Surgery is rarely needed.

What are the symptoms?

For most people, tennis elbow hurts only when they use the forearm and wrist, especially for twisting movements like turning a door handle or opening a jar. For some, the pain is constant, even at rest, and can disturb sleep. The pain may travel down the forearm from the elbow toward the wrist. It can be hard to hold a knife and fork, a cup or a pen, or to straighten the arm fully, and some people notice stiffness in the arm.

Golfer's elbow is a similar problem that causes pain on the inner side of the elbow. For other causes of elbow pain, see elbow pain treatment.

What causes tennis elbow?

The pain is where tendons from the forearm muscles attach to the bone on the outside of the elbow. It is thought to come from swelling or thickening of the tendon and, over time, wear and breakdown of the tendon tissue.

This damage usually comes from overusing the forearm muscles with repeated actions, such as wringing out clothes or manual work, especially twisting movements like using a screwdriver. Tennis and other racquet sports can cause it too, but despite the name, they cause only a small share of cases. Tennis elbow usually affects your dominant arm, the one you write with.

Who gets tennis elbow?

Tennis elbow is most common in middle age, roughly between 40 and 50, and affects men and women equally. It is more likely when the forearm muscles are not used to the work, for example if you suddenly play a lot of tennis on vacation, or take on a home project or gardening without being used to strong forearm work. Even people used to heavy work can overdo it. Jobs with a lot of repeated gripping and twisting, such as carpentry, painting, plastering, construction and housekeeping, carry a higher risk. If your elbow was hurt at work, our workers' compensation care page explains how we can help.

How is tennis elbow treated?

Change the activities that bring on your symptoms

You will soon notice which movements trigger your pain. Lifting, gripping and twisting with the affected arm usually make it worse, so avoid them as much as you can. Resting from these activities gives the tendon a chance to heal, and for some people, cutting out repetitive arm or hand movements is enough on its own.

If you think your job is contributing, talk with your doctor and your employer. You may be able to do different tasks at work while your elbow heals. Taking regular breaks while you work is a good idea for everyone.

Pain relief

Ice can help. Try an ice pack, such as a bag of frozen peas wrapped in a towel, on the tender area for about ten minutes, twice a day.

Pain relievers such as acetaminophen may help, and anti-inflammatory medicines such as ibuprofen are often used. Some anti-inflammatories come as creams or gels you rub over the elbow, which tend to cause fewer side effects than pills. Ask your doctor or pharmacist which is safe for you. These medicines ease pain, but they do not seem to improve the condition in the long term, and they can have side effects.

Physical therapy

Physical therapy has been shown to help tennis elbow. Your physical therapist may use hands-on techniques such as massage, along with exercises to strengthen the forearm and load the tendon gradually. Kinesiology taping can support the area during activity, and focused shockwave therapy may be added for tendon pain that has not settled with rest and exercise.

Studies have found that physical therapy may not relieve pain as well as a steroid injection in the first six weeks or so, but it may do better than injections over the long term.

Steroid injection

If these steps do not work, or if the pain is severe and you have trouble using your arm, a physician may suggest an injection of a corticosteroid into the painful area of the elbow.

Studies have shown that steroid injections can ease pain in the short term, and in one study, success rates at six weeks were higher with an injection than with physical therapy or waiting. That short-term relief can be worth it, for example before an important event. Even if an injection eases your pain, you still need to rest the arm and avoid the activities that brought the pain on. Build your activity back up over several weeks to lower the chance of the pain returning. An injection can sometimes be repeated if the pain comes back, but doctors limit the number of injections in the same spot.

When to see a doctor

• The pain lasts more than a few weeks despite rest and ice, or wakes you at night.
• Your elbow is swollen, red or hot.
• You have numbness, tingling or weakness in your hand.
• The pain started after a fall or a hard blow to the elbow.

How Precision Care Medical & Sports Performance helps with tennis elbow

Our sports medicine physicians and physical therapists focus on finding the best non-surgical treatment to resolve your pain. Your visit starts with an exam of the tendons and nerves, and the physician may use in-office diagnostic ultrasound to look at the tendon. Read more about how we treat elbow, wrist and hand pain. We are in network with Medicare, Medicaid and many commercial plans, and we treat work injuries under workers' compensation and car accident injuries under no-fault. See insurance for details.

Related care at Precision Care Medical & Sports Performance

Where to get tennis elbow treatment near you

Elbow pain is evaluated and treated at our Brooklyn, Staten Island and Midtown Manhattan offices. Occupational therapy for hand and arm problems is offered at our Brooklyn office. You can request an appointment online or call the office closest to you. An online request is not a confirmed booking until the office contacts you.

Our physicians treat tennis elbow at all three offices: Brooklyn serving patients from Sheepshead Bay, Midwood, Brighton Beach and Bensonhurst, Staten Island serving patients from Dongan Hills, Todt Hill and Eltingville, and Midtown Manhattan. If you are searching for occupational therapy near me for grip and forearm rehab, it is offered only at our Brooklyn office on Shell Rd, convenient to Brighton Beach and Bensonhurst. If the elbow pain started at work, see our workers’ compensation page, or request an appointment.

Questions patients ask

Educational only, not medical advice. These videos and this article explain common treatments in general terms. They are not a diagnosis or a treatment plan for you. Results vary from person to person. See a qualified clinician about your own symptoms, and call 911 or go to an emergency room for an emergency.

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