(Lateral Epicondylitis)

Understanding the Causes, Treatment, and Recovery

What is Tennis Elbow?

Tennis elbow, medically called Lateral Epicondylitis or Lateral Elbow Tendinopathy, is one of the most common causes of pain on the outer side of the elbow.

Despite its name, most patients with tennis elbow do not play tennis. It commonly affects individuals between the ages of 35 and 60 years and can interfere with work, sports, and daily activities.

The condition occurs due to damage to the tendon of the Extensor Carpi Radialis Brevis (ECRB) muscle, which attaches to the lateral epicondyle of the humerus.

Why is it Called Tennis Elbow?

Tennis players can develop this condition due to repetitive backhand strokes. However, it is equally common in:

What Causes Tennis Elbow?

The condition usually develops because of repetitive overuse of the forearm muscles.

Common reasons include:

Repetitive Activities

• Typing and mouse use
• Lifting heavy objects
• Repetitive gripping
• Using screwdrivers or tools
• Racquet sports
• Gardening
• Painting

Sudden Increase in Activity

• New exercise routines
• Unaccustomed manual work
• Intensive sports training

Poor Technique

• Incorrect sports techniques
• Improper workstation ergonomics
• Weak shoulder and forearm muscles

What Happens Inside the Tendon? (Pathophysiology)

Contrary to popular belief, tennis elbow is not primarily an inflammatory condition.

It is better described as a degenerative tendinopathy.

The tendon undergoes:

Microscopic Tears

Repeated stress causes tiny injuries within the tendon.

Poor Healing Response

The tendon has limited blood supply and struggles to repair itself.

Degeneration

The collagen fibres become disorganised and weakened.

Angiofibroblastic Hyperplasia

Abnormal blood vessels and nerve endings develop inside the tendon, contributing to chronic pain.

Why Does the Pain Persist?

The damaged tendon becomes mechanically weak and biologically abnormal, leading to persistent pain during gripping and lifting activities.

Symptoms of Tennis Elbow

Patients commonly complain of:

✔ Pain over the outer side of the elbow

✔ Pain while gripping objects

✔ Difficulty lifting a kettle or pan

✔ Pain while shaking hands

✔ Difficulty opening jars

✔ Weak grip strength

✔ Pain while using a computer mouse

✔ Pain during sports activities

How is Tennis Elbow Diagnosed?

The diagnosis is usually made through:

Clinical Examination

Tenderness over the lateral epicondyle.

Pain on:

• Resisted wrist extension
• Resisted middle finger extension
• Gripping activities

Imaging

X-rays

Usually normal but help exclude arthritis.

Ultrasound

May show tendon thickening and tears.

MRI

Useful in chronic cases and can demonstrate:

• Partial tendon tears
• Tendon degeneration
• Associated ligament injuries

Treatment of Tennis Elbow

Fortunately, most patients improve without surgery.

Treatment progresses from simple measures to advanced interventions.

Phase 1: Activity Modification

• Avoid repetitive gripping
• Reduce heavy lifting
• Modify sporting activities
• Correct workplace ergonomics

Phase 2: Medications

• Anti-inflammatory medications
• Ice application
• Pain-relieving gels

These mainly control symptoms and do not heal the tendon.

Phase 3: Physical Therapy

Physical therapy forms the cornerstone of treatment.

Goals of Physiotherapy

Reduce Pain

Ice, modalities, and activity modification.

Stretch Tight Muscles

Gentle forearm stretching exercises.

Eccentric Strengthening Exercises

These exercises have shown good evidence in improving tendon health.

Improve Shoulder and Scapular Function

Weak shoulder muscles can overload the elbow.

Improve Grip Strength

Correct Biomechanics

Many patients improve significantly with a structured physiotherapy programme over 8-12 weeks.

Bracing

A counterforce elbow strap may:

✔ Reduce stress on the tendon

✔ Improve comfort during activities

✔ Allow continuation of rehabilitation exercises

Steroid Injection

Corticosteroid injections can provide:

✔ Rapid pain relief

✔ Reduced inflammation around painful tissues

However:

❌ Benefits are often temporary

❌ Recurrence rates are high

❌ Repeated injections may weaken the tendon

❌ Multiple injections may increase the risk of tendon degeneration

Steroid injections are therefore used selectively and are not considered a long-term solution.

Platelet-Rich Plasma (PRP) Injection

PRP is prepared from the patient’s own blood and contains a high concentration of growth factors.

The goal is to:

✔ Stimulate tendon healing

✔ Promote tissue regeneration

✔ Reduce pain

✔ Improve tendon quality

Advantages of PRP

• Biological treatment
• Uses the patient’s own blood
• Addresses tendon degeneration rather than merely masking symptoms

What to Expect

Pain relief may take:

• 6-12 weeks
• Continued improvement for several months

Several studies have shown favourable long-term outcomes with PRP, especially in chronic tendinopathy.

When is Surgery Needed?

Fortunately, only a small percentage of patients require surgery.

Surgery may be considered if:

• Symptoms persist for more than 6-12 months
• Failure of physiotherapy and injections
• Persistent pain affecting quality of life
• MRI shows significant tendon degeneration or tearing

Arthroscopic Release of Tennis Elbow

At DocJoints, selected patients may benefit from arthroscopic tennis elbow release.

The procedure is performed through keyhole surgery.

The Surgeon:

✔ Visualises the elbow joint

✔ Identifies the diseased ECRB tendon

✔ Removes degenerated tissue

✔ Releases the damaged tendon portion

✔ Treats any associated joint problems

Advantages of Arthroscopic Surgery

✔ Small incisions

✔ Less postoperative pain

✔ Ability to treat associated intra-articular pathology

✔ Faster recovery

✔ Early mobilisation

✔ Excellent cosmetic results

Recovery After Arthroscopic Release

Time	Recovery
First few days	Gentle movements
2-6 weeks	Physiotherapy and stretching
6-12 weeks	Strengthening exercises
3-4 months	Return to sports and heavy activities

Most patients experience significant pain relief and improved function.

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Frequently Asked Questions

Will Tennis Elbow Heal by Itself?

Many cases improve with appropriate treatment, but chronic cases may persist if tendon degeneration is severe.

Is It an Inflammatory Condition?

No. It is primarily a degenerative tendon condition.

Is Surgery Common?

No. Most patients improve with physiotherapy and biological treatments such as PRP.

Can I Return to Sports?

Yes. Most patients return to normal activities and sports following appropriate treatment.

Is there a “mouse hack” for Tennis Elbow?

A vertically tall (handshake-position) mouse keeps the forearm in a neutral position instead of forcing it into pronation.

Why it helps

A conventional mouse causes:

• Forearm pronation
• Continuous wrist extension
• Increased activity of the wrist extensor muscles (ECRB)

A vertical mouse:
✅ Reduces forearm pronation
✅ Decreases strain on the extensor tendons
✅ Keeps the wrist in a natural handshake position
✅ Reduces pain during prolonged computer use