Tennis Elbow

Pain on the Outside of the Elbow

Pain is usually located over the bony prominence on the outer side of the elbow.

Pain While Gripping

Opening jars, shaking hands, carrying shopping bags, or holding tools becomes uncomfortable.

Pain During Lifting

Symptoms often increase when lifting objects, particularly with the palm facing down.

Weak Grip Strength

Many people notice their grip feels weaker because of pain.

Forearm Pain

Discomfort may spread from the elbow into the upper forearm.

Pain During Computer Work

Extended mouse use or repetitive typing may aggravate symptoms in some individuals.

Sports-Related Pain

Pain often increases during tennis, badminton, squash, golf, climbing, or weight training.

Morning Stiffness

Some people notice mild stiffness or discomfort when first using the arm in the morning.

Repetitive Overload

Repeated gripping, lifting, or wrist extension can exceed the tendon's ability to recover.

Tendon Degeneration

Modern research suggests tennis elbow is primarily a tendinopathy, involving changes within the tendon rather than ongoing inflammation.

Sudden Increase in Activity

Rapid increases in workload, gym training, gardening, or sporting activity may overload the tendon.

Poor Technique

Incorrect lifting technique or sports technique may increase stress on the extensor tendons.

Inadequate Recovery

Repeated loading without sufficient recovery time may contribute to tendon overload.

Muscle Weakness

Reduced strength or endurance in the forearm, shoulder, or scapular muscles may increase stress on the elbow.

Office Workers

Frequent mouse use and repetitive keyboard tasks.

Manual Workers

Electricians, carpenters, mechanics, plumbers, painters, and construction workers.

Racquet Sport Players

Tennis, badminton, squash, and pickleball.

Golfers

Although golfer's elbow is different, some golfers may also develop lateral elbow tendinopathy.

Weightlifters

Heavy gripping and repetitive pulling exercises.

Individuals Aged 35–60 Years

Peak age for tendon-related elbow disorders.

People Returning to Activity Too Quickly

Sudden increases in training volume or workload increase tendon loading.

Clinical Assessment

Medical History

• Pain location
• Duration of symptoms
• Occupation
• Sporting activities
• Repetitive gripping tasks
• Previous elbow injuries
• Aggravating movements

Physical Examination

• Elbow movement
• Wrist movement
• Grip strength
• Tenderness over the lateral epicondyle
• Functional tasks

Special Tests & Imaging

Special Tests

• Cozen's Test
• Maudsley's Test
• Mill's Test
• Grip strength assessment
• Cervical spine screening if indicated

No single special test confirms tennis elbow. Diagnosis is based on your history, examination findings, and clinical reasoning.

Imaging

Routine imaging is usually not necessary. Ultrasound or MRI may be considered when symptoms persist despite rehabilitation, another diagnosis is suspected, or surgery is being considered.

Education

Understanding tendon healing, modifying aggravating activities, and maintaining appropriate loading are essential.

Progressive Exercise Therapy

Gradual tendon-loading exercises are considered the cornerstone of treatment.

Manual Therapy

Joint mobilization and soft tissue techniques may provide short-term pain relief when combined with exercise.

Activity Modification

Reducing excessive gripping or repetitive wrist extension while maintaining general activity supports recovery.

Bracing

A counterforce elbow strap or wrist brace may provide temporary symptom relief for some individuals but should not replace rehabilitation.

Medication

Short-term pain relief may be appropriate under medical supervision. Long-term reliance on anti-inflammatory medication is generally not recommended for chronic tendinopathy.

Injections

Corticosteroid injections may provide short-term pain relief but are associated with poorer long-term outcomes compared with exercise alone.

Surgery

Surgery is rarely required and is generally reserved for persistent symptoms that do not improve after 6–12 months of well-managed conservative treatment.

Target: Common extensor tendon

Hold: 30–45 seconds

Repetitions: 4–5 holds

Target: Wrist extensor tendons

Repetitions: 10–15 × 3 sets

Precaution: Lower the weight slowly over 3–5 seconds.

Target: Wrist extensors

Repetitions: 10–15 × 2–3 sets

Target: Forearm and hand muscles

Repetitions: 10–15 squeezes × 2–3 sets

Target: Forearm rotators

Repetitions: 10–15 × 2 sets

Target: Middle trapezius and rhomboids

Repetitions: 12–15 × 2 sets

Build Tendon Strength

Regular progressive strengthening improves tendon capacity and resilience.

Warm Up Before Sport

Prepare the forearm, wrist, and shoulder muscles before racquet sports or weight training.

Improve Technique

Correct tennis, badminton, golf, or lifting technique reduces unnecessary tendon loading.

Increase Training Gradually

Avoid sudden increases in playing time, gym volume, or work demands.

Improve Workplace Ergonomics

Optimize desk setup and avoid prolonged repetitive gripping without breaks.

Strengthen the Shoulder and Upper Back

Strong shoulder and scapular muscles help distribute forces more efficiently throughout the upper limb.

Golfer's Elbow (Medial Epicondylalgia)

Elbow Pain

Radial Tunnel Syndrome

Cubital Tunnel Syndrome

Distal Biceps Tendinopathy

Wrist & Hand Pain

Cervical Radiculopathy

Shoulder Pain

Repetitive Strain Injury (RSI)

Forearm Tendinopathy