Tennis elbow (lateral epicondylitis)
Pain on the outside of the elbow that makes it hard to lift a mug, turn a key or shake someone's hand is nearly always the same condition.
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Medicines commonly prescribed for Tennis elbow (lateral epicondylitis)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: GEL, 10 mg/gActive substance: diclofenacManufacturer: Kern Pharma S.L.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 100 mgActive substance: ibuprofenManufacturer: Nutra Essential Otc S.L.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 684 mgActive substance: ibuprofenManufacturer: Laboratorio De Aplicaciones Farmacodinamicas S.A.Prescription not required
Pain on the outside of the elbow that makes it hard to lift a mug, turn a key or shake someone's hand is nearly always the same condition. It has a medical name, lateral epicondylitis, and an everyday one, tennis elbow, which is how everybody knows it. The popular name is convenient because that is what people search for, and unhelpful because it misleads: the great majority of those who get it have never picked up a racket.
Tennis has very little to do with it
On the outside of the elbow, at the bony point called the lateral epicondyle of the humerus, the tendons of the muscles that straighten the wrist and fingers come together. Those muscles work every time the hand holds something: to close the fingers, the wrist has to be locked in extension. That explains the whole picture. It is not the joint that suffers and there are no "deposits" involved — it is the tendon attachment, most often that of the short radial wrist extensor.
Anyone can develop it who uses the hand repeatedly and with force:
- painters, tilers, joiners, electricians, mechanics — anything involving a screwdriver, a drill, a spanner or a brush;
- cooks and butchers, hairdressers, massage therapists, musicians;
- people who spend the day on a mouse and keyboard;
- anyone who has just increased their load sharply: doing up a flat themselves, a house move, a new tool, a first month at the gym;
- and yes, racket players — but they are the smaller share.
It usually turns up between the ages of thirty-five and fifty-five, and almost always in the dominant arm. If tendons are painful not only at the elbow but also at the heel, knee or shoulder, this may be a broader story — overload tendinopathy, which has its own page. Here we are talking about one particular elbow.
What it feels like
This pain is fairly easy to recognise.
- It hurts on the outside of the elbow, and your finger lands on one exact spot: the bony point or just below it. Sometimes even light touch is sore.
- The pain trails down the outside of the forearm towards the wrist.
- The most telling feature is pain on gripping. Lifting a full mug, pouring from a kettle, opening a jar, turning a key, shaking hands, picking up a frying pan. The object may weigh almost nothing: what matters is the effort of the hand, not the weight.
- Lifting something palm-down and straightening the wrist against resistance hurt; palm-up is usually easier.
- In the morning the elbow is stiff and the first movements are unpleasant, then it loosens.
- Grip strength drops, things occasionally slip out of the hand, and that frightens people more than the pain does.
What does not belong to this condition: obvious swelling of the joint, redness, or being unable to bend and straighten the arm fully. A slight loss of full extension does happen, but an elbow that is swollen and will not move is something else.
Looks like it, but isn't
It pays to be careful here, because almost anything gets called tennis elbow.
- Numbness and pins and needles in the fingers point to a nerve, not a tendon. Numbness in the little and ring fingers with pain on the inner side of the elbow suggests compression of the ulnar nerve; a deep aching pain in the upper forearm with weakness when straightening the fingers suggests compression of the radial nerve. Both are treated differently, and extensor exercises can make them worse.
- Pain on the inner side of the elbow is a different condition, medial epicondylitis or golfer's elbow. The mechanism is similar but the flexor muscles are involved, and the exercises are not the same.
- Pain with swelling, redness and a temperature is not overload. A hot, red, swollen elbow needs urgent assessment: that is how infection of the joint or of the bursa over it presents, and it will not wait.
- Neck pain radiating into the arm, especially if it worsens on turning the head and comes with numbness, may be a nerve root in the neck, with the elbow simply on the route.
- An elbow swollen like a cushion at the back, while movement is almost painless, is olecranon bursitis, a quite different story.
A sharp snap with sudden severe pain during a strain is unusual here, but it can mean the tendon has pulled off the bone; that needs to be seen by a doctor the same day.
Why complete rest does not cure it — and how long it takes
The "-itis" ending suggests inflammation, but in a long-standing epicondylitis the tendon tissue shows not inflammatory cells but remodelling: disordered collagen fibres and small new blood vessels. Rest does not rebuild that tissue. Hence the modern approach: not complete rest, but modifying the load and adding exercise.
Modifying the load means removing the movements that leave you worse the following day and keeping everything else. An arm immobilised in a sling loses strength within a fortnight, and the pain comes straight back on the first day at work.
The second thing worth knowing in advance, and which is rarely said out loud: this is slow. The usual course runs from several months to a year, sometimes longer. Improvement comes in waves: two good weeks, then one hard day's work and it feels like a step backwards. A slow course does not mean the treatment is failing, and it is not a reason to change tack every three weeks, abandon the exercises or accept the next procedure on offer. The good news is that the overwhelming majority recover without surgery.
Extensor exercises: what and how
These are the backbone of treatment and, unlike most of the rest, they are in your own hands.
- Start with isometrics if it is very sore. With the forearm supported and the hand over the edge of a table, palm down, the good hand presses gently from above while the affected one holds the position without moving for several tens of seconds. A few sets. That alone often quietens the pain for a couple of hours.
- The main exercise is lowering the hand slowly. Forearm on the table, hand hanging over the edge holding a small weight. Lift the hand with help from the good arm, then lower it with the affected one only, slowly, to a count of three or four. That is the eccentric phase, which is the whole point.
- The weight starts absurdly light — a half-litre bottle of water, a half-kilo dumbbell — and goes up every week or two. Without progression the tendon does not remodel.
- Add grip work. Squeezing a soft ball or a hand exerciser, wringing out a towel, rotating the forearm with a weight. The aim is to get strength back, not just to take pain away.
- Do not forget the shoulder and shoulder blade. A weak shoulder girdle makes the forearm do the work of two, and that is one reason some people recover and others do not.
- The next-morning rule. Moderate pain during the exercise is fine. If the following morning is clearly worse than the day before, use less weight or fewer repetitions next time.
Work almost daily or on alternate days, in short sets, and carry on for a month or two after the pain has gone. The first programme is best set up with a physiotherapist, who will also check for the weakness or numbness that would point to a nerve.
Grip, tools and the workplace
Exercises will not outweigh eight hours of the same load that caused the pain. What is usually needed is a small number of changes that actually matter.
- A thicker handle is an easier tendon. Padded tool grips, a sleeve on a bag handle, a wide knife handle all reduce the gripping effort.
- Hold less in mid-air. Rest the forearm, put the workpiece on the bench, use a support, instead of holding the weight out at arm's length.
- Use two hands where you have always used one: lifting the pan, carrying the bag, holding the tool.
- Palm up, not palm down. Lift objects palm-up and close to the body rather than snatching them at arm's length with the palm down.
- Power tools instead of hand tools when there is a lot of screwing to do: a cordless driver takes a noticeable load off.
- Mouse and keyboard. Elbow in by the body at roughly a right angle, wrist not cocked upwards, forearm supported. A mouse that keeps the hand on its side helps, and so do short breaks every hour.
- Increase load gradually. Doing up a whole flat over one weekend, or a new racket with an unfamiliar stiffness, is the classic way this starts.
Braces, injections and machines: what to expect
Braces. The strap worn on the forearm just below the elbow — a counterforce brace — redistributes the pull and gives some people useful relief while they work. There is another option, a wrist splint that holds the hand in slight extension, which unloads things differently. But a brace on its own does not cure anything. It is a way of getting through the working day with less pain, not a substitute for the exercises. Wear it during activity rather than round the clock: constant use weakens the muscles.
Steroid injections. This needs saying plainly. An injection into the tender point takes the pain away quickly and convincingly, for some weeks. But at six to twelve months the people who were injected do worse than those who did exercises: they relapse more often. Injections should not be repeated into the same spot, because they weaken the tendon. And if one has been given, that is all the more reason not to plunge straight back into full work: the pain has been switched off, the tendon has not changed.
Painkillers and gels. Reasonable as a short course, to sleep and to be able to exercise. They do not solve the problem.
Machines and the rest. Shockwave therapy sometimes helps in drawn-out cases, but alongside the exercises. Therapeutic ultrasound and laser are widely offered and have no convincing evidence behind them. Platelet-rich plasma is the same: plenty of offers, little proof.
Surgery. Rarely discussed, usually after a year of treatment genuinely carried out. Recovery afterwards also takes months, so it is not a short cut.
Online consultation
A remote appointment covers three things here. First, establishing whether this is what it is: the doctor will ask exactly where it hurts, what sets it off, whether there is numbness or weakness, and will separate epicondylitis from a trapped nerve, from pain coming out of the neck, from bursitis, and from infection that needs to be seen at once. Second, going through your day: what you work with, how you hold the tool, what can be changed in your grip and at your desk or bench by tomorrow. For this the remote format is arguably better than a clinic visit, because you can show your own workplace and your own tools. Third, running the exercise programme and keeping it going through the months when nothing seems to be changing: adjusting weight and tempo, deciding when to progress, and heading off both the temptation to stop halfway and the temptation to accept another injection. A separate reason to get in touch: numbness, loss of grip strength, or an elbow that has turned red and hot.
This material is for information only and does not replace medical advice.
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