What is tennis elbow?
Tennis elbow, known medically as lateral epicondylitis or lateral elbow tendinopathy, is an overuse injury of the tendons that attach your forearm muscles to the bony bump on the outside of your elbow (the lateral epicondyle). The tendon most often involved belongs to a muscle called the extensor carpi radialis brevis (ECRB), which helps steady your wrist when you grip.
The name ends in "-itis", but research shows tennis elbow isn't mainly an inflammation problem. It's better described as tendon degeneration: repeated small amounts of damage that the tendon can't fully repair, which leaves it weaker and painful. That's why rest alone often doesn't fix it, and why targeted strengthening exercises are central to recovery.
Common tennis elbow symptoms
Symptoms usually come on gradually over weeks or months rather than after one injury. The most common tennis elbow symptoms are:
- Pain on the outer elbow, often described as burning or aching, centred on the bony bump.
- Pain that spreads down the forearm toward the wrist, along the back of the arm.
- Weak grip, such as trouble holding a jar, a pan, a briefcase or a racket.
- Pain with everyday tasks like shaking hands, turning a key or doorknob, lifting a kettle, or using a screwdriver.
- Tenderness to touch just in front of and below the lateral epicondyle.
- Morning stiffness in the elbow or forearm that eases as you move.
- Pain when you straighten your wrist against resistance, such as lifting something with your palm facing down.
Symptoms can be mild and only noticeable after heavy use, or severe enough to disturb sleep and make simple tasks painful. Usually only one arm is affected, most often the dominant one.
What causes tennis elbow?
Tennis elbow develops when the forearm extensor tendons are loaded more often or more heavily than they can recover from. Common triggers include:
Repetitive work and hobbies
Jobs and activities that involve repeated gripping, twisting or wrist extension are the biggest cause. Examples include carpentry, plumbing, painting, butchery, assembly-line work, hairdressing, gardening, knitting, and long hours at a keyboard and mouse.
Racket and throwing sports
In tennis, poor backhand technique, a racket grip that's the wrong size, strings that are too tight or a sudden jump in playing time can overload the tendon. Squash, badminton, pickleball, padel and golf can all contribute too.
A sudden increase in activity
A weekend of DIY, moving house, a new gym routine or a burst of gardening in spring often comes just before symptoms start. Tendons adapt slowly, so sudden spikes in load are a classic trigger.
Contributing factors
Smoking, obesity, diabetes, and some medications (such as fluoroquinolone antibiotics) have been linked to tendon problems in general, and may make tennis elbow more likely or slower to heal.
Who is most at risk?
Tennis elbow affects an estimated 1–3% of adults each year. It's most common between the ages of 35 and 55, when tendons naturally become less resilient. It affects men and women about equally. Less than 10% of people with tennis elbow actually play tennis. Manual workers and office workers who repeat the same movements for hours make up a much larger share.
How tennis elbow is diagnosed
A GP, sports medicine doctor or physiotherapist can usually diagnose tennis elbow from your history and a short physical exam. They will typically:
- Ask about your job, hobbies, sports and when the pain started.
- Press around the outer elbow to find the exact tender spot.
- Do a few resistance tests, such as Cozen's test (lifting your wrist against resistance with your fist clenched), Mill's test (gently stretching the wrist extensors) and Maudsley's test (resisting extension of the middle finger). Pain on the outer elbow during these tests points strongly to tennis elbow.
- Check your grip strength, neck and shoulder movement, and nerve function to rule out other causes.
Scans usually aren't needed. Ultrasound or MRI may be used if the diagnosis is unclear, if symptoms last longer than six to twelve months, or if surgery is being considered. An X-ray can rule out arthritis or problems with the bone.
Conditions that feel similar
| Condition | How it differs from tennis elbow |
|---|---|
| Golfer's elbow | Pain is on the inside of the elbow and worse when you bend your wrist toward your palm. |
| Radial tunnel syndrome | A nerve problem that causes a deeper ache a few centimetres below the elbow, sometimes with weakness. |
| Pain coming from the neck | Comes with neck pain, tingling or numbness that travels down the arm. |
| Elbow arthritis | Causes stiffness, clicking or locking, and difficulty fully straightening or bending the elbow. |
When to see a doctor
Get medical advice promptly if you have: swelling, redness or heat around the elbow; a fever; numbness or tingling in your hand; pain after a fall or a direct blow; an elbow you can't straighten or bend; or pain that hasn't improved after 4–6 weeks of self-care.
For most people, though, tennis elbow can be managed well at home. Once you know the symptoms, the next step is building a plan. Our guide to tennis elbow treatment options explains what works, and our tennis elbow brace guide explains how to ease pain while you stay active.
Frequently asked questions
Can you get tennis elbow without playing tennis?
Yes. Most people with tennis elbow don't play tennis. Any repetitive gripping or wrist movement, such as typing, using a mouse, painting, plumbing or gardening, can cause it.
Does tennis elbow show up on an X-ray?
Usually not. Tennis elbow is a tendon problem and is normally diagnosed with a physical exam. Imaging such as ultrasound or MRI is only used if symptoms are unusual or don't improve.
Is tennis elbow the same as golfer's elbow?
No. Tennis elbow affects the outside of the elbow (lateral epicondyle), while golfer's elbow affects the inside (medial epicondyle). Both are overuse tendon injuries.