Tennis Elbow (Lateral Epicondylitis): A Patient’s Guide to Understanding and Healing

Posted by Eric J. Sanders, MD | Shoulder & Elbow Specialist

Tennis elbow, medically known as lateral epicondylitis, is one of the most common causes of elbow pain. Despite the name, only about 5% of those diagnosed with tennis elbow actually play tennis. In fact, the majority of cases result from repetitive motions at work or during daily activities—not sports.

What Causes Tennis Elbow?

Tennis elbow is caused by repetitive microtears in a tendon on the outside of the elbow. This tendon connects to the muscles that help extend your wrist. While the term "epicondylitis" implies inflammation, the condition is actually degenerative rather than inflammatory. It’s more accurate to think of it as a tendon tear, where the tissue becomes disorganized and weakened during the repair process.

Because this healing tissue is structurally weaker than healthy tendon, it’s vulnerable to re-injury—especially when repetitive or strenuous use continues. This re-injury delays healing and contributes to ongoing pain.

Common Symptoms

Patients with tennis elbow often experience:

• Pain directly over the bony bump on the outside of the elbow

• Discomfort during everyday activities, such as:

  • Lifting a jug of milk out of the fridge

  • Turning a doorknob with the palm down

  • Carrying objects with the thumb up or palm down

These motions are commonly involved in jobs, childcare, exercise, and other daily tasks, making tennis elbow a frustrating condition to manage.

Pain in this region is a signal that the tendon is being re-injured, and it often indicates a setback in healing. The goal of treatment is to protect the tendon, reduce stress on it, and allow the body time to heal naturally.

Non-Surgical Treatment: The Gold Standard

Most cases of tennis elbow do not require surgery. Treatment focuses on:

• Avoiding re-injury

• Correcting biomechanics and ergonomics

• Strengthening and stretching the involved muscles

Dr. Sanders' Treatment Recommendations:

1. Avoid Re-Injury

• Use your non-dominant hand when possible for lifting.

• If lifting is necessary, turn your palm upward (supinated position).

• For desk workers:

  • Use an ergonomic mouse and keyboard setup

  • Keep wrists neutral and supported

• If pain occurs during sleep, consider wearing a wrist guard to improve sleep posture.

2. Use a Counterforce Strap

• A tennis elbow strap can help reduce strain on the tendon.

• Use it only during unavoidable activities that cause discomfort. It supports—not replaces—the need to modify activity.

3. Begin Eccentric Strengthening and Stretching

• Perform gentle eccentric exercises for the forearm muscles.

• Start with short 10-minute sessions, 2–3 times per day.

• Physical therapy or a guided home exercise program is often helpful.

4. Try the Theraband FlexBar (Tyler Twist Exercise)

• This tool helps with eccentric training of the wrist extensors.

• Keep one nearby at your work desk or living area as a reminder to stay consistent.

5. Use Anti-Inflammatories for Pain Relief

• Over-the-counter medications like ibuprofen (Advil) or naproxen (Aleve) can reduce pain.

• Remember, these do not accelerate healing—they simply relieve symptoms.

6. Consider Additional Therapies

• Modalities like shockwave therapy, mechanical massage, and dry needling may offer relief.

• Evidence is mixed, but they’re generally safe and may be worth trying under guidance.

7. Platelet-Rich Plasma (PRP) Injections

• If symptoms persist for 3 months despite consistent care, a PRP injection may help stimulate healing.

• These injections are not covered by insurance and may require a series of 1–3 treatments.

• There’s no firm evidence on how many injections are most effective.

8. Avoid Cortisone Injections

• Steroid injections may relieve pain temporarily but disrupt the tendon’s healing process.

• In my experience and review of the literature, steroid use increases the likelihood of needing surgery by up to 30%.

• Long-term, they are not worth the risk in most cases.

When Is Surgery Necessary?

The good news is that most people recover without surgery. However, the healing process is slow:

• About 80% of patients feel significantly better within 6 months

• Up to 95% are pain-free by 18 months

Surgery is typically reserved for those who:

• Have had 9+ months of non-surgical care

• Still experience significant, function-limiting pain

Surgical treatment involves:

• Removing the damaged tendon tissue

• Releasing the tendon from the bone

Recovery takes 5–6 months, and while surgery is often successful, about 30% of patients may still have some mild discomfort, and 5% may not experience improvement.

Final Thoughts

Tennis elbow can be frustrating, but it is treatable without surgery in the vast majority of cases. The key to success is patience, consistency, and protection:

• Modify activities and ergonomics

• Use your strap wisely

• Be diligent with stretching and strengthening

• Avoid quick fixes like steroid injections

• Consider PRP if your symptoms persist

Healing takes time, but with the right plan, most patients return to full function without the need for surgery.

If you have questions or aren’t seeing progress, I’m here to help guide your recovery.

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