Tennis elbow

Definition
Tennis elbow is a painful condition caused by overuse or repetitive strain of the forearm extensor muscles, leading to inflammation and microtearing of the tendons attaching to the lateral epicondyle of the humerus. Despite its name, it is common in non-athletes performing repetitive wrist and forearm activities.

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Causes

• Repetitive wrist extension or gripping activities (sports, manual work, typing, use of tools)

• Overuse of the extensor carpi radialis brevis tendon

• Poor ergonomics or incorrect sports technique

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Risk Factors

• Age 30–50 years

• Occupations involving repetitive wrist/forearm use (e.g., carpenters, plumbers, painters, computer users)

• Racquet sports with improper technique or equipment

• Sudden increase in activity level

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Pathophysiology

• Microtears and degeneration (tendinosis) of extensor carpi radialis brevis tendon

• Inflammatory changes in early stages; degenerative changes predominate in chronic cases

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Clinical Features

• Gradual onset of lateral elbow pain

• Pain worsens with wrist extension, gripping, or lifting objects with the palm facing down

• Tenderness over the lateral epicondyle

• Weak grip strength

• Possible radiation of pain down the forearm

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Diagnosis

• Primarily clinical based on history and examination

• Pain reproduced by:

  • Resisted wrist extension with elbow extended

  • Resisted middle finger extension

• Imaging (ultrasound, MRI) if diagnosis uncertain or symptoms persist

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Treatment

General Measures

• Rest from aggravating activities (not complete immobilisation)

• Apply ice packs to affected area for 15–20 minutes several times daily

• Ergonomic modifications in work or sport

• Physiotherapy to strengthen and stretch forearm muscles

Medications

• NSAIDs (oral or topical) for pain relief

• Topical diclofenac or ibuprofen gels for mild cases

Adjunctive Therapies

• Counterforce brace (forearm strap) to reduce strain on tendon

• Physiotherapy including eccentric strengthening exercises

• Shockwave therapy in persistent cases

Interventional

• Corticosteroid injections for short-term relief (avoid repeated injections due to risk of tendon weakening)

• Platelet-rich plasma (PRP) injections in refractory cases

• Surgical tendon release/debridement if severe and persistent >6–12 months despite conservative treatment

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Prognosis

• Most cases resolve within 6–12 months with conservative treatment

• Recurrence possible if ergonomics and technique not corrected

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Quick-Reference Clinical Chart — Tennis Elbow

Feature	Details
Cause	Overuse injury to forearm extensor tendons, especially extensor carpi radialis brevis
Main symptoms	Lateral elbow pain, worsens with wrist extension/gripping
Risk factors	Age 30–50, repetitive forearm use, racquet sports, manual work
Diagnosis	Clinical exam: tenderness at lateral epicondyle, pain with resisted wrist/middle finger extension
First-line treatment	Rest, ice, NSAIDs, physiotherapy, counterforce brace
Adjunct options	Corticosteroid injection, PRP, shockwave therapy
Surgery	For refractory cases after 6–12 months of failed conservative care
Prognosis	Usually resolves in 6–12 months; recurrence possible