In short
Tennis elbow is pain on the outside of the elbow from an overloaded forearm tendon. Most people who get it have never played tennis. It usually gets better on its own, though it can take 6 to 12 months, and about 9 in 10 people have recovered within a year without treatment. Easing off the aggravating activity and gradual strengthening are the mainstays. Injections can make long-term results worse, and surgery has not been shown to beat non-surgical care.
On this page
What is tennis elbow?
Tennis elbow causes pain on the outside of the elbow and weakness in the forearm. Its medical names are lateral epicondylitis and lateral elbow tendinopathy. The problem is in the tendon that anchors the muscles on the back of your forearm, the ones that lift your wrist and fingers, to the bony bump on the outer side of the elbow.1,2
Tennis elbow symptoms
- Soreness on the outside of the elbow, which can spread into the upper arm and forearm
- Pain when you grip, shake hands, turn a doorknob or lift a kettle
- Tenderness when you press on the outer elbow
- A weaker grip1
Pain on the inner side of the elbow is a similar condition called golfer’s elbow.2
Pain that keeps coming back?
Talk it through with an Australian doctor online. No referral needed.
What causes tennis elbow?
Repeated use of the wrist and arm. Tennis is one cause, but so are rowing, using a screwdriver or hammer, painting, plumbing, cutting meat and typing.1
In a Finnish population study of nearly 4,800 adults, 1.3 per cent had definite tennis elbow, and it was most common between the ages of 45 and 54. Men and women were affected equally. The risk was highest in people whose work combined forceful and repetitive arm movements, and smokers had about three times the odds of non-smokers.3
How long does tennis elbow last?
Tennis elbow usually gets better on its own, but slowly. Recovery can take 6 to 12 months.1
The best evidence comes from an analysis of the untreated and placebo groups in randomised trials. About half of the people who still had symptoms were recovered or greatly improved every two and a half to three months. By one year, 89 per cent had improved. How long someone had already had the pain made no difference to their chances.4
That last point is reassuring. Having had tennis elbow for months doesn’t mean it has become permanent.
How to treat tennis elbow
Ease the load
Cut back on whatever set it off, without resting the arm completely. Keep active, and avoid the movements that hurt.1 Lifting with your palm facing up puts less load on the sore tendon than lifting with your palm down. Ice packs can help with pain.1
A stretch to try
Hold the sore arm straight out with your fingers pointing to the floor. With your other hand, gently press on the back of the hand to bend the wrist further. Hold for 30 seconds and repeat three times, once a day.1
Strengthening exercises
If the pain hasn’t improved after 6 to 12 weeks, see a physiotherapist. They can set up exercises to stretch and strengthen the forearm muscles and suggest changes to how you do particular tasks.1
The evidence for exercise is weaker than you might expect, mostly because tennis elbow improves by itself. A Cochrane review of 23 trials found that the studies were at high risk of bias,5 and one meta-analysis found no clear advantage for strengthening programs over no active treatment.6 Exercise is still a reasonable choice. It is safe, and it rebuilds strength for work and sport.
A brace or strap
A strap worn around the forearm can take some load off the tendon during tasks that aggravate it.1
Injections
An injection can ease pain for a few weeks, but it doesn’t stop tennis elbow from coming back.1 Pooled results from seven trials found that people who had an injection ended up with worse pain and function than those in the comparison groups.6 They are used less often for tennis elbow than they once were.
Surgery
Surgery is rarely needed, and it carries a risk of reduced grip strength.1 A systematic review of 12 studies concluded that surgery for tennis elbow was no more effective than non-surgical or sham treatment, although the studies were of poor quality.7
Can you prevent it?
- Take regular breaks from tasks that work your wrist and elbow repeatedly
- Keep your elbows slightly bent when you lift
- Check your equipment. A racquet that is too heavy or has the wrong grip size adds load1,2
- Build forearm strength gradually before a big increase in activity
When to see a doctor
- Pain that is getting worse
- Pins and needles or numbness in your arm or fingers
- Unusual swelling, redness or heat around the elbow, or a fever
- Your fingers or arm change colour1
- The elbow is painful after a fall, or you can’t straighten it
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- healthdirect. Tennis elbow.
- Better Health Channel (Victorian Government). Elbow pain.
- Shiri R, Viikari-Juntura E, Varonen H, et al. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006;164(11):1065-74.
- Ikonen J, Lähdeoja T, Ardern CL, et al. Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clin Orthop Relat Res. 2022;480(4):647-660.
- Wallis JA, Bourne AM, Jessup RL, et al. Manual therapy and exercise for lateral elbow pain. Cochrane Database Syst Rev. 2024;5(5):CD013042.
- Lapner P, Alfonso A, Hebert-Davies J, et al. Nonoperative treatment of lateral epicondylitis: a systematic review and meta-analysis. JSES Int. 2022;6(2):321-330.
- Bateman M, Littlewood C, Rawson B, et al. Surgery for tennis elbow: a systematic review. Shoulder Elbow. 2019;11(1):35-44.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.