Tennis Elbow

What is tennis elbow?

Tennis elbow, or lateral epicondylitis, is an overuse injury of the wrist extensor tendons at their attachment to the bony prominence on the outside of the elbow. According to the AAOS, it is a gradual, wear-related process of tendon overload - not a sudden tear or fracture.

Despite the name, most people with tennis elbow have never played tennis. The condition is common in anyone who performs repetitive hand and forearm motions - computer work, manual labor, lifting, sports, even cooking and gardening.

An important point: in most cases this is not a classic active inflammation, but a process of tendon degeneration and overload. That is exactly why "painkillers and rest" alone are often not enough.

What does tennis elbow feel like?

Patients with tennis elbow often describe:

• Pain or burning on the outside of the elbow
• Pain radiating down the forearm, sometimes to the wrist
• Pain when shaking hands
• Pain when lifting objects - a cup, a kettle, a grocery bag
• Pain when opening a jar or turning a handle
• Pain with prolonged typing or mouse work
• Weakness of grip
• Morning stiffness in the elbow
• Pain that flares after activity, and sometimes aches at rest

The Mayo Clinic describes the pain of tennis elbow as starting where the forearm tendons attach to the bony bump on the outside of the elbow, with pain that can spread into the forearm and wrist.

Beyond the medical definition, there is a real everyday cost. Tennis elbow can interfere with work, training, sleep, and the most basic tasks of daily life.

Why does an accurate diagnosis matter?

Not every elbow pain is tennis elbow.

Pain on the outside of the elbow can also come from nerve entrapment (radial tunnel syndrome), from the joint itself, from the neck radiating down the arm, from myofascial pain in the forearm muscles, or from a combination of several factors. And sometimes pain on the inner side of the elbow turns out to be golfer's elbow - a related problem on the other side.

The difference matters, because the treatment is not the same.

With tennis elbow we need to understand: How long has the pain been present? Is the tendon in an irritated stage or a degenerative one? Is there a neural or cervical component? Is the patient a candidate for conservative care, medical dry needling, prolotherapy, an ultrasound-guided treatment, or a different plan?

An accurate diagnosis saves time, pain, and treatments that do not fit the stage the patient is in.

Why "waiting for it to pass" is not always enough

It is true that most cases of tennis elbow improve over time. But the process can take many months - according to the AAOS, six months to a year and sometimes longer - and time alone is not a treatment plan.

While waiting, a patient may go through persistent pain, declining grip strength, an impact on work and training, and a growing tendency to avoid using the arm.

More than that - the wrong load on an irritated tendon can perpetuate the problem. Pushing through work and exercise without modification keeps the tendon inflamed. On the other hand, complete and prolonged rest weakens the tendon and the muscles - and the pain returns the moment activity resumes.

So the key question is not "rest or no rest." The key is to manage load correctly, control the pain, and strengthen the tendon gradually.

Our approach at Team Clinic 360°

At Team Clinic 360° we do not look at tennis elbow as just another "sore elbow."

We look at the whole picture:

• How the pain began - suddenly or gradually
• Which activities make it worse and which ease it
• How long the problem has been present and what has already been tried
• The nature of your work, sport and daily load on the arm
• Whether there is radiation, numbness or neural signs
• Whether the neck or shoulder are part of the picture
• Whether the inner side of the elbow is tender as well
• Grip strength and overall function

The exam includes a focused clinical evaluation, specific tendon loading tests, and at times the use of diagnostic ultrasound - to assess the tendon and rule out other problems.

Your evaluation and treatment are led by Dr. Lior Shem Tov, a specialist in anesthesiology and pain medicine, and Dr. Natalie Siegel, a specialist in family and pain medicine.

Treatment for tennis elbow

Treatment for tennis elbow depends on how long the problem has been present, the intensity of pain, the condition of the tendon, your functional demands, and your medical background.

In suitable cases, treatment options may include:

• Assessment by a pain physician and a full clinical evaluation
• Diagnostic ultrasound as needed
• Load management - at work, in sport and in daily life
• Medication to reduce pain, when appropriate
• Physical therapy focused on graded tendon strengthening
• Ultrasound-guided medical dry needling of the tendon region and forearm muscles
• Prolotherapy - injections aimed at stimulating a healing response in the tendon
• Ultrasound-guided injections in suitable cases
• A counterforce elbow brace, when helpful
• A structured, graded home exercise program

A word about corticosteroid injections: current evidence shows they can ease pain in the short term, but in tennis elbow they do not improve long-term outcomes - and in some studies they make them worse. That is why we weigh them carefully, and in many cases prefer approaches aimed at the healing of the tendon itself.

There is no single treatment that fits everyone. There is a tendon. There is a stage. There is a person. And there is a plan that has to fit them.

The value of ultrasound guidance

When an interventional treatment is chosen - dry needling, prolotherapy or an injection - precision is everything.

The elbow is a crowded region: tendon, joint, the radial nerve, blood vessels. The advantage of ultrasound-guided treatment is the ability to see the tendon in real time, identify the damaged area precisely, and direct the treatment exactly there - not "approximately."

Not every patient needs an injection. But when chosen well, a precise treatment can be the difference between another failed attempt and the beginning of real recovery.

Tennis elbow or a problem coming from the neck?

Sometimes elbow pain does not start in the elbow.

Pressure on a nerve root in the neck can radiate pain down the arm to the elbow and forearm. Myofascial pain from the forearm and shoulder muscles can mimic tennis elbow. And nerve entrapment near the elbow can feel very similar - yet require a completely different treatment.

That is why, in our exam, we do not stop at the elbow. We also examine the neck, the nerves and the muscles - because precise treatment starts with the right address.

When should you come in for an evaluation?

It is worth considering a visit to a pain physician or a clinic that focuses on pain if:

• The elbow pain has lasted more than a few weeks
• The pain returns every time you go back to activity
• Your grip strength is declining
• The pain interferes with work, training or sleep
• Rest and painkillers have not brought stable improvement
• You had a corticosteroid injection and the pain came back
• There is numbness, tingling or radiation down the arm
• It is unclear whether the problem is the tendon, a nerve or the neck

StatPearls notes that tennis elbow is most common after age 40, affects men and women equally, and usually involves the dominant arm.

What happens at the appointment?

At the appointment we carry out a medical evaluation aimed at understanding whether this is tennis elbow, what stage it is in, and whether other factors are involved.

The appointment may include:

• An in-depth medical conversation
• A clinical exam of the elbow, forearm and wrist
• Specific tendon loading tests
• Examination of the neck, shoulder and radiating areas as needed
• Diagnostic ultrasound based on clinical need
• Review of previous tests and imaging
• Evaluation of suitability for conservative care, dry needling, prolotherapy or an ultrasound-guided injection
• Building a clear treatment direction

The goal is for you to leave with an understanding: what is happening in the elbow, what stage the problem is in, and what can be done now.

What to bring to the appointment

We recommend coming with:

• Previous visit summaries
• Ultrasound / MRI / X-ray reports, if you have them
• A list of medications and treatments you have tried
• A short summary: when the pain started, what makes it worse, what eases it, and what you can no longer do
• Records of physical therapy, injections or previous treatments, if any

Frequently asked questions