Tennis Elbow (Lateral Epicondylitis): Pain on the Outer Elbow

Symptoms and Differentiation

• Tenderness over the bony prominence on the outer elbow
• Pain when turning a door handle, opening a jar and lifting a cup
• Sharper pain on shaking hands and lifting the wrist
• Reduced grip strength
• Tightness spreading along the outer forearm

If the pain is on the inner side of the elbow, the condition is golfer's elbow (medial epicondylitis) rather than tennis elbow. The distinction is made on examination and determines which exercises are used.

Who Is Affected?

• People working with hand tools: carpenters, plumbers, butchers, painters
• Long-term keyboard and mouse users
• Racquet sports, particularly with faulty technique
• Those who increase gripping loads abruptly during weight training
• The 40–60 age range

Diagnosis and Treatment

Diagnosis is largely clinical; the exact site of pain and pain on resisted wrist extension are the key findings. Ultrasound and MRI are not required in every patient.

Treatment centres on load management and graded exercise: reducing rather than eliminating the aggravating activity, progressive loading of the forearm muscles, stretching, review of workplace ergonomics, a forearm strap and a night splint. Corticosteroid injection may relieve pain in the short term but repeated injections can weaken the tendon; the decision is individual. Surgery is considered in a small proportion of patients whose symptoms persist for many months.