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Tennis elbow (lateral epicondylitis)
Last reviewed: 05.07.2025
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Lateral epicondylitis (tennis elbow) develops as a result of inflammation or micro-tear of the tendons of the extensor muscles of the forearm that attach to the lateral epicondyle of the distal humerus.
Symptoms of lateral epicondylitis include pain in the area of the lateral epicondyle of the humerus, extending to the forearm.
[ Causes of Tennis Elbow (Lateral Epicondylitis)
Pathophysiological theories for the development of lateral epicondylitis include nonathletic and occupational activities that require repetitive and forceful pronation and supination of the forearm and overuse, weakness, or both of the extensor carpi radialis longus and brevis, which are forearm muscles that originate from the lateral epicondyle of the ulna. For example, during a backhand shot in tennis, the elbow and wrist are extended, and the extensor tendons, particularly the extensor carpi radialis brevis, may be injured as the ball rolls over the lateral epicondyle and radial head. Predisposing factors include poor technique, weak shoulder and wrist muscles, tightly strung rackets, ill-fitting racket grips, poorly hitting heavy, wet balls, and hitting the ball off-center on the racket.
When used against resistance, lateral epicondylitis most commonly occurs with arm flexion, various types of scooping movements, and back exercises that involve lifting the torso, especially when the arms are in a pronated position. Often, injuries result from overuse (too much activity or doing the same movements with a high number of repetitions) or muscle imbalances between the forearm flexors and extensors.
Symptoms of Lateral Epicondylitis
Initially, pain occurs in the extensor tendons when the wrist is forced against resistance (e.g., when manually tightening a screw or hitting a backhand with a racket). The pain may radiate from the lateral epicondyle to the middle of the forearm; over time, subperiosteal hemorrhages, calcification, a spur-like growth on the lateral epicondyle, and, most importantly, tendon degeneration may occur.
Pain along the extensor tendon of the fingers when the fingers are extended against resistance and the elbow is straightened is a reliable diagnostic sign. The diagnosis can be confirmed if the same pain occurs during the following examination: the patient is seated on a chair with the elbow straightened, the hands are placed on the table with the palm down; the doctor places his hand firmly on the back of the patient's hand, and the patient attempts to bend the wrist.
Where does it hurt?
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Treatment of tennis elbow
Treatment of tennis elbow involves two phases. Initially, rest, ice, NSAIDs, and stretching are used, along with cortisone injections into the painful area around the tendon. Once the pain has subsided, gentle resistance exercises of the forearm flexors and extensors are performed first, followed by eccentric and concentric resistance exercises. Avoidance of activities that cause pain with the wrist extended or pronated is essential. The use of elbow pads is often recommended when playing tennis. Good technique and the type of racket used can help prevent further injury.
Although the need for surgical treatment of lateral epicondylitis is rare, surgical treatment for lateral epicondylitis involves removing scarring and degenerative tissue at the insertion site of the extensor tendons.