Tennis Elbow Symptoms

Tennis elbow is a major pain for tennis players. For some it’s technique, for others it’s just bad luck. But what are the symptoms you should look out for? Here’s the top symptoms you should look out for (and the treatment you need).

Below you’ll get the full guide to getting back on the court ASAP. We researched the best information available and combined it into this definitive guide. And when you’ve finished here’s the 17 best tennis elbow exercises 

Tennis Elbow Symptoms

Adapted: Tatiana from Moscow, Russia / CC BY-SA (https://creativecommons.org/licenses/by-sa/2.0)

How To Improve Your Tennis In 7 Days

Get Tennis Lessons From The World's Best

Don't just watch videos - Get actionable feedback on YOUR play

The Secret to Improving Your Tennis

Get world class lessons cheaper than your local court. Plus do it in your time (perfect for busy people). Record a video of your play and let a world class tennis player give you direct feedback on what to improve - From just $10

All About Tennis Elbow

Tennis Elbow is a health condition that mainly affects the forearm and elbow. It is a type of swelling of tendons, which is called tendinitis. Tendinitis causes pain in the arm and elbow. Tendons are tough tissue bands that connect the lower arm muscle to the bone.

Despite the name Tennis Elbow, this condition isn’t associated specifically with tennis or racquet sports. Anyone can get tennis elbow, even those who haven’t played it ever in their lives. It basically happens due to repetitively performing gripping activities, primarily actions that make use of the thumb and first two fingers.

Tennis elbow is one of the most common reasons for which people visit their doctors for elbow pain. It can appear at any age, but it is most common among people 40 years or above. It is a self-limiting condition so, it eventually gets better without undergoing any treatment. However, the pain may last from a few weeks to several months, and in some cases, it lasts even a year. That’s because tendons inflammation takes longer to heal. In this article, you will get to know all about tennis elbow, what causes it, how to diagnose it, and what kind of treatments are there to treat it.

Anatomy of the Elbow

Our elbow joint comprises of three bones- upper arm bone called the humerus, and two forearm bones called ulna and radius. At the bottom of the humerus there are bony bumps, which are called epicondyles. The bump on the lateral or outer side of the elbow is called the lateral epicondyle. Muscles, tendons, and ligaments hold the elbow joint together. Tennis elbow is also called lateral epicondylitis because it involves the tendons and forearm muscles. Our forearm muscles extend the wrist and fingers while the forearm tendons, known as extensors, attach the muscles with the bone, which stick on the lateral epicondyle. The tendon that’s involved in tennis elbow is known as the Extensor Carpi Radialis Brevis (E.C.R.B.).

What Causes Tennis Elbow?

Tennis elbow doesn’t develop overnight; it takes some time for the condition to develop. Such as, repeatedly gripping a racket during a swing can cause tennis elbow to develop over time because it strains the muscle and puts a lot of stress on the tendons. This constant tugging eventually causes microscopic tears in the tissue.

Some sporting activities can lead to tennis elbow, such as tennis, squash, racquetball, weight lifting, and fencing, etc. However, there are some hobbies or occupations that also involve repetitive gripping or arm movements, such as typing, carpentry, painting, knitting, and raking, etc.

Watch this video to understand what causes Tennis Elbow.

According to recent studies, tennis elbow is caused because of damage to a specific forearm muscle, the extensor carpi radialis brevis/E.C.R.B. This muscle helps in stabilizing the wrist whenever the elbow is straight, which usually happens during a tennis groundstroke. From overuse, the E.C.R.B. gets weakened and microscopic tears form in the area where the tendon attaches to the lateral epicondyle leading to inflammation and pain. Because of its sensitive position, the E.C.R.B. is at an increased risk of damage since the elbow regularly bends and straightens that keeps rubbing the muscle against the bony bumps. Gradually it leads to muscle wear and tear.

However, athletes aren’t the only people who develop tennis elbow, but those who regularly participate in recreational activities or works that involve vigorous, repetitive use of the forearm muscle. These include plumbers, painters, carpenters, etc. Studies suggest that auto workers, butchers, and even cooks can get tennis elbow more often than anyone else because of the repetitive actions and weight lifting that these professions involve.

Age is another factor that causes tennis elbow to develop over time. Many patients of tennis elbow are between the age of 30 and 50. However, anyone can get it if they are exposed to the risk factors. In racquet sports such as tennis, improper stroke technique, or equipment could be the main risk factors.

Moreover, lateral epicondylitis can also occur without any known repetitive injury. This kind of occurrence of tennis elbow is called unknown or insidious cause.

Remember that tennis elbow symptoms develop gradually. Initially, the pain is very mild and slow. It worsens over several weeks or months. Therefore, you should be alarmed when you experience chronic pain around the forearm and elbow region, and you are exposed to specific risk factors, as mentioned above.

Symptoms of Tennis Elbow

The main symptoms of tennis elbow include tenderness in the bony knob and pain on the elbow’s outside. This knob is present right at the point where the injured tendon is linked to the elbow. This pain can transcend to the lower or upper arm as well. Though the elbow is the only part of the forearm that is damaged, you will find it hard to do things with your hand as the pain will quickly pass on to other areas. Usually, people feel pain when performing activities like lifting or grip something like a tennis racket, opening the door, shaking hands, make a fist, straightening the wrist, or raising your hand, etc. The condition is also called Golfer’s Elbow, in which the tendons on the interior side of the elbow gets injured.

Check out this video to learn more about tennis elbow symptoms.

How is Tennis Elbow Diagnosed?

A thorough exam would be necessary to diagnose tennis elbow. The doctor will ask you to flex your arm, elbow, and wrist to examine where it hurts most. You may also undergo imaging tests like an M.R.I. (magnetic resonance imaging) or an X-Ray to rule out other problems. During the physical examination, your doctor will apply some pressure on the affected area and will ask you to move your forearm in several ways. Your medical history will also be required to make the correct diagnosis.

Here is a video to learn more about Tennis Elbow treatment and diagnosis.

How to Treat Tennis Elbow?

There are several possible treatment options that the doctor may suggest. Here’s a brief overview of all available options:

Therapy

The doctor may suggest therapy if your tennis elbow symptoms are associated with tennis. The doctor will request you to evaluate your tennis shots, technique, and movement to reduce stress on the injured tissue. A physical therapist will help you learn specific exercises to strengthen and stretch your muscles gradually, especially the forearm muscles. In this regard, eccentric exercises are incredibly helpful; it involves slowly lowering your wrist after raising it. Moreover, depending on the condition, the therapist will suggest a forearm brace or strap to minimize stress on the injured tissue.

Check this video for more information on helpful stretching exercises for Tennis Elbow.

Therapy also involves avoiding or modifying activities that put a strain on the affected muscles and tendons. For instance, if you carry out tasks like lifting using your arms, you will have to avoid such tasks until you feel improvement in the pain. Alternatively, you should modify the way you perform such movement to prevent excessive strain on the arm.

Painkillers and NSAIDs

Painkillers like paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen can help alleviate mild inflammation and pain caused by tennis elbow.  You may find relief with topical NSAIDs as these are available in gel and cream forms, as well as tablets.

Topical NSAIDs can be directly applied to any area such as the forearm or elbow to ease the pain for some time. These are usually recommended for musculoskeletal conditions like tennis elbow instead of the tablets. That’s because tablets may cause side effects like diarrhea and nausea, whereas topical treatment doesn’t cause any such side effects.

Some of the NSAIDs are available as over-the-counter drugs, and you don’t need a prescription to purchase them. However, some are only available on prescription. Your pharmacist or G.P. can recommend the appropriate NSAID after examining your condition.

Physiotherapy

If your tennis elbow is causing severe and more persistent pain, then your G.P. might refer you to a physiotherapist. Physiotherapists are certified healthcare professionals who try to restore movements to injured body parts using a variety of exercises and physical treatment methods. Initially, your physiotherapist will use manual therapy techniques like manipulation of movement and massage to relieve stiffness and pain and regulate the flow of blood to the arm. They may also help you learn exercises to keep your arm mobile and for strengthening your forearm muscles. If needed, they will suggest orthoses such as support bandage, brace, strap, or splint for a brief period.

Steroid injections

Steroids are a specific type of medication containing a manmade version of the cortisol hormone. A steroid may sometimes be used for treating musculoskeletal issues like tennis elbow. The doctor may suggest steroid injections if other treatment options do not work. These injections are administered directly into the painful area. Before receiving the injection, you may be given a local anesthetic to numb the area around the elbow to reduce the pain.

 

For short-term pain relief, steroid injections are beneficial. However, in the long-term, their effectiveness is low. If you find the treatment helpful, you will be given up to three steroid injections in the same area. There will be at least three to six months gap between each injection.

Shockwave therapy

Shockwave therapy is one of the best forms of non-invasive tennis elbow treatment. It involves passing high-energy shockwaves through the skin to relieve pain and promote normal movement in the injured/affected area. The number of shockwave therapy sessions a patient may require depends on the pain’s severity. A local anesthetic may be administered first to reduce any discomfort or pain during the procedure.

According to the National Institute for Health and Care Excellence (NICE), shockwave therapy is a safe and reliable treatment option. However, it may sometimes cause minor side effects such as skin bruising or reddening in the area that is receiving the treatment. Shockwave therapy has proven to help improve tennis elbow pain in most of the cases. But, it doesn’t always work for every patient.

Learn more about shockwave therapy for treatment of tennis elbow in this video.

P.R.P. injections

Platelet-rich plasma (P.R.P.) is a relatively new type of treatment for musculoskeletal problems, including tennis elbow. P.R.P. injections can only be offered by a surgeon and administered in a hospital. These are blood plasma containing concentrated platelets that are injected to repair damaged tissues. P.R.P. injections speed up the healing process in many patients, but since this is a newer form of treatment, so the long-term effectiveness of P.R.P. injections is yet unknown.

During the procedure, the surgeon will take a blood sample from the patient and place it in a machine that separates the healing platelets. These platelets are then injected into the affected joint(s). The entire procedure takes around 15 minutes to complete.

Check this video for more information on PRP injections.

Surgery

Surgery is always the last resort in tennis elbow treatments. It is considered the extreme form of therapy that is only opted for when nothing else has proven effective in relieving the pain.

A majority of surgical procedures for tennis elbow involve removing the torn or diseased muscle and reattaching healthy muscle to the bone. A range of factors will be considered before suggesting the surgical approach to treat tennis elbow. These include the scope of injury, the patient’s general health, and their personal preferences.

Through surgery, the tendon’s damaged part is surgically removed to relieve the symptoms of pain. The doctor will wait for at least 6 to 12 months before suggesting surgery to remove damaged tissue. The surgical process can be performed via a single large incision or several smaller incisions. After the surgery, rehabilitation exercises are mandatory for a full recovery.

Ultrasonic Tenotomy:

T.E.N.E.X. procedure or ultrasonic tenotomy is a process in which a doctor inserts a special needle through the skin into the tendon’s damaged portion. This process is conducted under ultrasound guidance. The needle vibrates swiftly with ultrasonic energy so that the damaged tissue liquefies and suctioned out.

F.A.S.T. Procedure:

Focused Aspiration of Scar Tissue (FAST) procedure is an innovative new minimally invasive method developed with the collaboration of Mayo Clinic’s Dr Bernard Morrey. It is designed to quickly and safely remove tendon scar tissue without moving the healthy tendon tissue around the damaged one. It is used for treating chronic tendon injuries and involves the percutaneous removal of abnormal tissue.

Here’s a video on FAST procedure for tennis elbow.

The process required the administration of local anesthesia and ultrasound guidance. It is performed after conducting an ultrasound evaluation to localize the injured tendon. Through local anesthesia, the affected skin and tissue are numbed, and a small (about 3mm) incision is made to remove the abnormal tissue and restore normal tendon function. The dressing is placed over the incision to encourage immediate motion without much mobilization.

The treatment takes no more than 15 minutes, and patients can use the arm for daily activities from the next day. However, they are instructed to avoid heavy lifting or rigorous movement for at least 6 to 8 weeks. It takes around 12 weeks for the patient to recover fully. This is an effective treatment because it causes minimal pain and downtime while the recovery process is 50% less than other standard operative procedures. The patient can resume day-to-day activities, usually without feeling much discomfort or problems.

Risks and Side Effects:

As with any surgical procedure, there are risks involved with tennis elbow surgery. The most common aftereffects of tennis elbow surgery include infection, blood vessel or nerve damage, the loss of strength/flexibility, and a need for further surgery. The rehabilitation and recovery process are also comparatively longer for surgical processes than other treatment options.

Lifestyle and home remedies

There are several self-care measures that your G.P. will recommend to speed up the recovery process. These include:

Resting- During treatment for tennis elbow, your doctor will ask you to avoid activities that may aggravate the elbow pain.

Pain Relieving Medications: Over-the-counter medications such as ibuprofen Advil or Motrin I.B. or Naproxen (Aleve).

Ice Packs: Cold pack or ice pack should be applied for at least 15 minutes, four times a day to lessen the pain.

Technique: The patient will need to modify the technique for specific activities and avoid repetitive wrist motions.

Rehabilitation After Surgery:

After undergoing a surgical procedure for tennis elbow, your arm will be temporarily immobilized with a brace or splint. After around one week the sutures and splint will be removed. Once the splint is removed, you will start stretching exercised to restore elbow and forearm’s flexibility. Gradual strengthening exercises will resume at least two months after the surgery. Your G.P. will inform you about when can you return to normal athletic activities. Typically, it takes up to 6 months after surgery to resume rigorous athletic activities. In around 90% of patients, tennis elbow surgery is considered successful but healing time vary from person to person. Never rush your recovery and do not push yourself before your tennis elbow is wholly healed or else the damage would be worse. You can return to the previous level of activity if you feel that gripping objects or lifting the weight from the affected arm don’t feel painful anymore, your elbow isn’t swollen anymore, and the injured elbow feels just as strong as the other elbow.

17 of the Best Tennis Elbow Exercises

We researched what the experts recommend to help treat your tennis elbow…

Here’s the tennis elbow exercises we recommend most people follow.