Tennis elbow is a wear-and-repair problem of the tendon that attaches the wrist-extensor muscles to the outer elbow, most often the ECRB tendon. Tendon problems typically occur in a spectrum, going from Inflammation, to small partial tear, mid-grade partial tear, high-grade partial tear, and finally fully tear. So despite the name 'itis,' it is usually less an active inflammation than a tendon that has degenerated and failed to heal, which is why it can be stubborn.
Pain sits at the bony point on the outside of the elbow and flares with gripping, lifting, or shaking hands. It is common in people who do repetitive gripping at work or in sport, and most people who have it have never played tennis.
Symptoms
Typical complaints include:
- Pain and tenderness over the bony point on the outer elbow
- Pain with gripping, lifting, or turning a doorknob or jar
- A weak or painful grip
- Symptoms often come on gradually rather than from a single injury
How it is diagnosed
It is largely a clinical diagnosis based on tenderness over the outer elbow and pain reproduced by resisted wrist and finger extension. Needs to be differentiated from Radial Tunnel Syndrome which can occur concomitantly. Imaging is reserved for cases that do not improve as expected or when another problem, such as outer-elbow instability or nerve irritation, is suspected.
Tennis elbow is treated patiently and conservatively, and based on what part of the spectrum the tendon problem is in. Dr. Lee emphasizes activity modification, a structured physical therapy emphasizing an eccentric exercise program, and a counterforce brace, the measures with the best track record.
Injections are typically offered if non-invasive measures fail. Those that are in the inflammatory part of the spectrum can benefit from a corticosteroid injection, which can calm a bad flare. However, if patients have a partial tear, steroid injections can actually be harmful since it weakens collagen tissue, and can promote a full tear. For these cases, PRP is probably the best option. Surgery to remove the degenerated tendon tissue is reserved for the small minority who do not improve after a genuine, extended course of conservative care, or for those that have a full thickness tear.
Non-surgical treatment
Most patients improve with a combination of:
- Activity modification to reduce provocative gripping
- A structured eccentric strengthening program with a physical therapist
- A counterforce brace and/or wrist splint to offload the tendon
- A corticosteroid injection for an inflammatory flare, PRP for a partial tear
When conservative care stalls
PRP (platelet-rich plasma) is sometimes used for tendons that are not healing. Surgery, which removes the degenerated portion of the tendon and stimulates healing, is reserved for the small minority with pain that persists after an extended, genuine trial of conservative treatment.
Recovery timeline
Recovery is usually measured in weeks to months, not days:
- Weeks 0 to 6Activity modification, bracing, and a structured exercise program. Expect gradual, not immediate, improvement.
- Weeks 6 to 12Continued strengthening and a graded return to gripping activities and sport.
- After surgery (rare)Splint for 4 weeks, then progressive strengthening over two to three months, full unrestricted activity - 4-6 months.
What patients commonly misunderstand
Three things to set straight:
- It is often not really inflammation. Tennis elbow is mostly commonly tendon degeneration rather than active inflammation, which is why rest alone often is not enough and a loading program works better.
- Repeated cortisone is not the answer. Steroid injections can weaken the tendon and ligament, and can lead to a full rupture, so they are used only when appropriate.
- Most cases never need surgery. The large majority of tennis elbow resolves with patience and rehabilitation, and maybe injections. Surgery is for the small minority who do not improve after an extended trial.
This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.