Lateral Epicondylitis (Tennis Elbow)

The elbow is a hinge joint formed by three bones:

• Humerus (upper arm bone)
• Radius and ulna (forearm bones)

The lateral epicondyle is the bony prominence on the outer (lateral) part of the humerus. Several forearm extensor muscles originate from this point, most notably the extensor carpi radialis brevis (ECRB), which helps extend and stabilize the wrist.
When you repeatedly extend or twist your wrist or forearm—such as during racquet sports, typing, or manual labor—tiny tears can develop in the tendon. Over time, these microtears lead to pain, inflammation, and degeneration at the tendon’s origin, causing lateral epicondylitis.

Symptoms typically develop gradually and worsen over time. Common signs and symptoms include:

• Pain and tenderness on the outside of the elbow
• Pain that radiates into the forearm and wrist
• Worsening pain with gripping, lifting, or twisting motions (e.g., turning a doorknob, shaking hands)
• Weak grip strength
• Pain that increases with activities involving wrist extension
• Stiffness in the elbow, especially in the morning

Symptoms may affect one or both arms but are more common in the dominant arm.

Lateral epicondylitis is typically caused by repetitive stress or overuse of the extensor tendons of the forearm, especially during:

Activities:

• Tennis (especially with poor backhand technique)
• Typing or computer use
• Carpentry or plumbing
• Knitting, gardening, or repetitive lifting

Risk Factors:

• Age: Most common between ages 30 and 50
• Occupation: Jobs requiring repetitive wrist and arm motion
• Sports participation: Racquet sports or repetitive motion sports
• Improper technique: Using poor body mechanics during physical activity

Diagnosis is usually made through a clinical history and physical examination:

Physical Exam:

• Tenderness at the lateral epicondyle
• Pain worsened by resisted wrist extension or middle finger extension
• Tests such as Cozen’s test or Mill’s test provoke symptoms

Imaging:

• X-rays: Usually normal but may rule out other issues like arthritis or bone spurs
• Ultrasound or MRI: Can show tendon degeneration or tears in persistent or unclear cases

Most cases of lateral epicondylitis can be managed effectively with non-surgical treatments, especially when addressed early.

Activity Modification

• Avoid or reduce repetitive motions that trigger symptoms
• Use proper technique during activities and sports
• Take frequent breaks during repetitive work

Rest and Ice

• Apply ice packs to the elbow for 15–20 minutes, 3–4 times per day
• Rest the arm, especially after overuse

Physical Therapy

• Stretching and strengthening exercises for the forearm, wrist, and shoulder
• Eccentric strengthening of wrist extensors is particularly effective
• Improve flexibility and balance in the muscles to reduce tendon strain

Bracing

• Use a forearm strap (counterforce brace) or wrist splint to reduce tendon stress during activities

Medications

• NSAIDs (e.g., ibuprofen, naproxen) help reduce pain and inflammation
• Topical NSAIDs or pain relievers may be used for mild symptoms

Corticosteroid Injections

• May provide temporary relief by reducing inflammation
• Typically reserved for short-term flare-ups
• Multiple injections are not recommended, as they may weaken the tendon over time

Platelet-Rich Plasma (PRP) Injections

• PRP is derived from the patient’s own blood and may promote healing in chronic cases
• Studies show mixed results, but PRP may be helpful for patients not responding to other treatments

Shockwave Therapy or Ultrasound

• Some patients benefit from extracorporeal shockwave therapy (ESWT) or therapeutic ultrasound, which may stimulate healing in the tendon