Tennis Elbow (Lateral Epicondylitis)

Medically Reviewed by Zilpah Sheikh, MD on October 11, 2023
8 min read

Tennis elbow, also known as lateral epicondylitis, is a type of tendinitis (swelling of the tendons) that causes pain in your elbow and arm. These tendons are bands of tough tissue that connect the muscles of your lower arm to the bone. 


Despite the name, you can get tennis elbow even if you've never been near a tennis court. Any repeated arm movement can inflame your tendons.

Tennis elbow is the most common reason for elbow pain. It can pop up in people of any age, but it most hits people between ages 30 and 60.

Tennis elbow usually develops over time. Repeated motions, like gripping a tennis racket during a swing, can strain your muscles and leave the work up to your tendons, causing them to become inflamed and ripe for microscopic tears. 

Tennis elbow might result from jobs or hobbies that require repeated arm movements such as:

  • Tennis
  • Racquetball
  • Squash
  • Fencing
  • Weightlifting
  • Carpentry
  • Typing
  • Painting
  • Raking
  • Knitting


The main symptom of tennis elbow is pain and tenderness in the bony knob on the outside of your elbow. This knob is where the injured tendons connect to the bone. 

The pain may also radiate into your upper or lower arm, and you can have tennis elbow in both arms. Although the tendon damage is in your elbow, you're likely to feel pain when doing things with your hands.

Tennis elbow pain may be most intense when you:

  • Lift something
  • Make a fist or grip an object, such as a tennis racket
  • Open a door or shake hands
  • Raise your hand or straighten your wrist

Talk to your doctor if you have any of these symptoms:

  • Trouble moving your arm(s)
  • A lump or bulge in your elbow or arm
  • Pain that keeps you from your everyday activities
  • Your elbow is red or swollen

Tennis elbow pain usually worsens over time. Talk to your doctor if your symptoms don't improve for several months.


Your doctor will ask about your symptoms and medical history. They’ll check for pain in parts of your arm and ask you to move your arm, elbow, wrist, and fingers in certain ways to see if you have discomfort.

They may also do more tests like:

  • Electromyography will help your doctor see whether you have a problem with the nerves in your elbow.
  • MRI can show how severe the damage is to the tendons in your elbow. It also can find arthritis in your neck or problems in your back that could cause pain in your elbow.
  • X-rays can look at the bones in your elbow to check for arthritis.

Rest is the best treatment for tennis elbow. It usually heals on its own if you can stop the constant movements that caused it. 

Here are other nonsurgical ways to treat tennis elbow: 

  • Ice: Experts recommend icing for 15 minutes every 3 to 4 hours to reduce pain and swelling. 
  • Mulligan mobilisation with movement and taping: This is a form of physical therapy that repositions the muscles to protect the injured tendons from further strain.
  • Physical therapy: A professional can show you exercises to strengthen and stretch the muscles in your shoulder, upper arm, and wrists.
  • Steroids: Shots into your elbow tendons can briefly ease some of the swelling and pain around your elbow joint. 
  • Botox: Studies show that these shots can treat chronic tennis elbow.
  • Needle fenestration: This treatment uses a special ultrasound to repeatedly guide a needle into the injured tendon to increase blood flow and promote healing. 
  • Ultrasonic tenotomy: Also called Tenex, this procedure uses ultrasound to guide a needle into the damaged tendon. Then the needle is vibrated with ultrasonic energy so fast, it turns injured tissue to liquid so it can be removed.
  • Platelet-rich plasma (PRP) therapy: Your platelets (cells in your blood that stop bleeding) are separated from your other blood cells and then injected back into the injured tendons to encourage healing.

Most of the time, these treatments will do the trick. You can also take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or aspirin, for pain and swelling. 

If you have a severe case of tennis elbow that doesn't respond to 2-4 months of  treatment, you may need surgery. You and your doctor will decide which type of surgery is best for you.

Surgical options include:

  • Open surgery. Your surgeon makes a cut above the bone on the side of your elbow, removes the damaged tendon, and reattaches the healthy part back to the bone. They might also remove a tiny piece of bone in your elbow to improve blood flow and help the area heal faster.
  • Arthroscopic surgery. Your surgeon makes a few tiny cuts in the skin over your elbow. Then they use very small instruments and a camera to perform the procedure.

With either type of surgery, the opening is closed with sutures (a row of stitches) or staples. Then it's covered with a bandage or other dressing. You should be able to go home on the same day as your surgery.

How long it takes to recover from tennis elbow depends on the extent of the damage to your tendon and your treatment.

But don't rush the healing process. If you start pushing yourself to use your arm too early, you could make the damage worse. 

You're ready to return to your former level of activity when:

  • Gripping objects or bearing weight on your arm or elbow is no longer painful.
  • Your injured elbow feels as strong as your other elbow.
  • Your elbow is no longer swollen.
  • You can flex and move your elbow without any trouble.

As much as you can, try not to overuse your elbow. Stop if you feel any elbow pain during an activity.

You can also:

In general:

  • Make sure your arms are strong and flexible.
  • Avoid repetitive arm and wrist movements.
  • Use your shoulder and upper arms to take the strain off your elbow.
  • Avoid bending or straightening your arm all the way.

At work

  • Avoid working with a bent wrist. Keep it straight, if possible.
  • Talk to your manager about rotating jobs, doing different tasks, or changing your workstation setup to reduce strain.
  • Hold tools with a looser grip to take some of the tension out of your hand.
  • If you use a hammer, use one with padding to help absorb shock.

For sports:

  • Stretch and warm up before any sport or activity that will exercise your elbow or arm.
  • If you have a coach, ask them to help with your form. The correct technique can help avoid injury.
  • When playing tennis, stick with a two-handed backhand.
  • Make sure you have fresh, dry tennis balls. Wet or "dead" tennis balls can aggravate your elbow.
  • Use equipment for your height and weight, especially when playing tennis and golf.
  • Ice your elbow after playing sports where you use your forearm.

Physical therapy is a common treatment for tennis elbow, whether you have surgery or not. Here are some of the exercises that may help your symptoms improve. 

Finger stretch:

  1. Place a rubber band around your fingers and thumb, and cup your hand. 
  2. Slowly spread your thumb and fingers apart and then close them.
  3. Do three sets of 10, and repeat 2-3 times a day.

If this starts to get too easy, use two rubber bands.

Ball squeeze:

  1. Hold a tennis ball or stress ball in your hand.
  2. Squeeze and release.
  3. Do this 10 times, and repeat 5-7 times a week.

If this movement causes you pain, use a softer object, like a sponge or balled-up socks.

Wrist stretch:

  1. Hold your arm straight out with your palm facing down. 
  2. Use your other hand to gently pull your fingers of your outstretched hand down toward your body until you feel the stretch in your inner forearm.
  3. Hold for 15 seconds. Repeat five times, then do the same motions with your other arm.
  4. Try this stretch up to four times a day.

Wrist stretch:

  1. Hold your arm straight out with your palm facing up, like you're telling someone to stop. 
  2. Use your other hand to gently pull your fingers of your outstretched hand toward your body until you can feel the stretch in your outer forearm.
  3. Hold for 15 seconds. Repeat five times, then do the same motions with your other arm.
  4. You can do this stretch up to four times a day.

Wrist turn:

  1. Bend your elbow to 90 degrees by your side so it forms an L.
  2. Hold your hand out, with your palm up.
  3. Gently turn your wrist so your palm faces down.
  4. Hold for 5 seconds, and then slowly release. 
  5. Do three sets of 10. 

Forearm strengthening:

  1. Bend your elbow 90 degrees. 
  2. Support your forearm on a table with your wrist hanging off the edge. 
  3. Slowly turn your palm so it faces up, moving only your forearm, not your elbow.
  4. Return your wrist to the start position, then slowly turn your palm down. Repeat.
  5. Do three sets of 10.

When you can do 2 days of 30 reps without pain, add a 1-pound dumbbell; then add a 3-pound dumbbell.

Towel twist:

  1. Hold a rolled-up towel in both hands, and relax your shoulders.
  2. Twist the towel in opposite directions (one hand rolling forward, the other pulling back), as if you’re wringing out water.
  3. After 10 twists, repeat, going in opposite directions.
  4. Do three sets of 10.

Elbow curls

  1. While standing, place one foot out in front of the other.
  2. Loop one end of a resistance band under your back foot and hold the other end (or the handle) with your palm facing up.
  3. Pull the band up and curl your arm toward your shoulder. 
  4. Do three sets of 10.

Before you start any new exercises, talk to your doctor. And if anything hurts or you feel any discomfort, stop and talk to your doctor. 

Tennis elbow is a type of tendinitis that causes pain in your elbow and arm. It's caused by repeated arm movements that trigger the muscles in your forearm to get tired, leaving the tendons to do all the work. Anybody can get tennis elbow, not just people who play tennis. It's usually treated with physical therapy, though rare cases may need surgery.  

What's the best way to fix tennis elbow?

Physical therapy can be a great way to help heal tennis elbow. Many exercises can help improve your symptoms. They can also help promote blood flow to your injured tendons, which can speed up your recovery.

How do you know if you have tennis elbow?

Tennis elbow has very clear symptoms, including pain on the outside of your elbow that travels to your wrist. You'll feel discomfort when you grasp small things, or when you twist or bend your arm.

What triggers tennis elbow?

Doing the same arm movements over and over is the most common cause. Repeated motions trigger the muscles in your forearm to get tired, leaving the tendons to do the work and become inflamed.