Tennis elbow

Tennis Elbow or Lateral Epicondylitis

Tennis elbow is a condition that causes pain around the outside of the elbow. It is clinically known as lateral epicondylitis and occurs following overuse of the muscles and tendons of the forearm, near the elbow joint.

You may notice pain:

  • on the outside of your upper forearm, just below the bend of your elbow
  • whilst lifting or bending your arm
  • when gripping small objects, such as a pen
  • if twisting your forearm, such as turning a door handle or opening a jar

You may also find it difficult to fully extend your arm.

What causes tennis elbow?

The elbow joint is surrounded by muscles that move your elbow, wrist, and fingers. The tendons in your elbow join the bones and muscles together and control the muscles of your forearm. Tennis elbow is usually caused by overusing the muscles attached to your elbow and used to straighten your wrist. If the muscles and tendons are strained, tiny tears and a change in the tendon pathology occurs near the bony lump (the lateral epicondyle) on the outside of your elbow.

As the name suggests, tennis elbow is sometimes caused by playing tennis. However, it is usually caused by other activities that place repeated stress on the elbow joint, such as decorating, gardening or playing the violin. I have seen very few tennis players with Tennis Elbow.

Pain that occurs on the inner side of the elbow is often known as golfer’s elbow.

What else could it be?

However, many patients have presented to the clinic with lateral elbow pain that is not actually tennis elbow. It is important to screen for other potential causes of lateral elbow pain which can include a disc bulge or nerve root impingement in the neck, radial nerve entrapment or even a condition known as thoracic outlet syndrome can refer pain to the elbow. It is important to identify the source and underlying cause of the problem to figure out the right course of management.


In saying that “Tennis Elbow” is a very common condition that lacks understanding of how complex it can actually be. Although the condition is labelled the same across many different people, management for the same condition can be very different for each patient. Again it comes back to understanding the underlying cause.


We have 5 muscles that attach to the common extensor origin at the lateral aspect of the elbow. It can depend on which action causes you the most amount of pain to identify which muscle or muscles can be responsible for your symptoms. Whether it be gripping, twisting jars, turning keys, pouring coffee, typing, etc. some muscle may need to be strengthened others off loaded or rested.

How is it treated?

Local treatment such as dry needling, massage, ice, heat, ultrasound, taping or bracing can help.  A loading exercise programme is also essential to aid recovery and prevent recurrence.

If you have lateral elbow pain lasting longer than a week come in for an assessment. The longer you leave it the longer it will take to get better.

Steroid injections are an option although the evidence shows that Physiotherapy is better.  An important aspect of treatment is to change the activity that caused it, if possible.

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