Tennis Elbow


Lateral epicondylalgia, or ‘Tennis elbow’ is a tendinopathy of the common extensor origin of the lateral elbow.


The main clinical symptoms are pain on resisted movements (particularly resisted third finger extension) and tenderness at the lateral epicondyle, with normal elbow range of motion. Diagnosis is based on the clinical features. Diagnostic imaging such as ultrasound, may be considered to rule out other causes of elbow pain or to establish the diagnosis of tennis elbow when in doubt.

Person with Tennis Elbow Pain


As with other tendinopathies, pathology is complex and not fully understood. Similar to calcifying tendinitis of the shoulder, sudden overload may alter the structure of the tendons at the common extensor origin, leading to a degenerative process. However, calcifications are rare in tennis elbow. The involvement of neurogenic inflammation in Tennis elbow has also been suggested.

Approximately 40% of all tennis players report problems with their elbow, but only a quarter of them consider the symptoms to be disabling and severe. Interestingly, most patients do not play tennis. This is due to the fact that many tennis players have a weekly training routine that regularly loads the tendons and keeps them healthy. Rather, the injury usually occurs in people who have been sedentary for years and then overuse a previously underused and atrophied tendon by exercising at the gym, doing gardening, or even just carry heavy luggage. When the injury is caused by playing tennis it is the backhand stroke that leads to excessive loading of the tendons at the common extensor origin.

‘The population prevalence is approximately 2%, with peak incidence occurring at 40 to 50 years of age.’

Eccentric (lengthening only) exercises have become the mainstay of rehabilitation programs. In most circumstances, cortisone injections should not be used. Cortisone injection leads to very good results in the short term (six weeks) but has been demonstrated to be harmful in the longer term (more than three months).

Shock wave therapy for tennis elbow may be considered in chronic cases.

Tennis Elbow