Tennis Elbow & Golfer's Elbow

What Is Tennis Elbow & Golfer's Elbow?

Tennis elbow, known medically as lateral epicondylitis, is a painful condition affecting the tendons on the outside of your elbow. These tendons attach muscles that straighten and stabilize your wrist. Over time, the tendon degenerates at its attachment point, weakening the anchor site and causing pain with gripping, lifting, and grasping activities.

Golfer's elbow, or medial epicondylitis, is the same condition but on the inside of the elbow, affecting the tendons that help you flex your wrist and fingers. Despite their names, these conditions affect far more people who don't play tennis or golf. They result from tendon degeneration rather than inflammation, which is why the pain can persist even when swelling isn't obvious.

Symptoms

The primary symptom is pain at the bony bump on either the outside or inside of your elbow. With tennis elbow, pain is located on the outer elbow and may radiate down the forearm toward the wrist. With golfer's elbow, pain is on the inner elbow and can extend down the inner forearm. The affected area becomes tender to touch, and even light pressure can be uncomfortable.

Pain typically worsens with activities that stress the affected tendons. Gripping objects, lifting items, turning doorknobs, shaking hands, or picking up a coffee cup can all trigger discomfort. You might notice the pain starts at the elbow and travels down your forearm. Weakness in the wrist and hand may develop, making it difficult to hold objects firmly. In severe cases, any movement of the elbow can be painful, even without added resistance.

Causes & Risk Factors

These conditions develop from repeated stress on the elbow tendons, leading to tiny tears and degeneration of the tendon tissue. This is most common in people between 30 and 50 years old, though it can occur at any age. The name tennis elbow comes from the fact that tennis players can develop this problem, but the condition is far more often caused by everyday activities.

Occupational activities are common culprits. Repetitive gripping and grasping motions at work, such as those performed by carpenters, plumbers, painters, mechanics, and butchers, can stress these tendons over time. Even office work involving extensive computer use and mouse clicking can contribute. Any activity that involves repeated wrist motions, forceful gripping, or awkward hand positions can increase your risk.

Sometimes these conditions develop after a direct blow to the elbow, which can cause swelling and make the tendon more susceptible to degeneration. Poor technique in sports or work activities, inadequate conditioning, and using equipment that doesn't fit properly can also contribute. In many cases, the condition develops gradually without a single clear cause, simply from the cumulative effect of daily activities.

Diagnosis

Diagnosis is usually straightforward and based on your symptoms and physical examination. Your hand surgeon will ask about your work, hobbies, and what activities make the pain worse. During the exam, specific tests can reproduce your pain by stressing the affected tendons. The location of tenderness over the bony bump on the elbow helps confirm the diagnosis.

Imaging studies are usually not necessary but may be ordered to rule out other conditions. X-rays can show if there are bone spurs or arthritis in the elbow. Ultrasound or MRI can visualize the tendon and show the extent of degeneration, though these are typically reserved for cases that don't respond to treatment or when the diagnosis is unclear.

Treatment Options

For many people, symptoms improve on their own within a year, though treatment can provide relief sooner and prevent the problem from getting worse. The first step is modifying activities that aggravate your symptoms. This doesn't necessarily mean stopping all activity, but rather adjusting how you perform tasks to reduce stress on the affected tendons. Using tools with larger grips, taking frequent breaks, and improving technique can all help.

A tennis elbow brace, worn around the forearm just below the elbow, can reduce tension on the tendon and provide relief during activities. Anti-inflammatory medications may help with pain, though these conditions involve degeneration more than inflammation. Ice applied after activities can soothe discomfort. Hand therapy can be beneficial, with therapists teaching specific stretching and strengthening exercises that promote healing.

If conservative treatments don't provide adequate relief after several months, additional options include corticosteroid injections to reduce pain and inflammation in the area. Some physicians offer injections of your own blood or platelet-rich plasma, treatments that show promise in research and may help stimulate healing in the degenerated tendon tissue.

Surgery is considered only when pain is severe and hasn't responded to at least six to twelve months of non-surgical treatment. The procedure involves removing the diseased, degenerated tendon tissue and is performed as an outpatient surgery. Most people exhaust conservative options before considering surgery, as non-surgical treatment is effective for the majority of cases.

Surgery: What to Expect

When surgery is necessary, it's performed as an outpatient procedure under local anesthesia, with sedation available for select cases if needed. The operation typically takes 30 to 45 minutes. The surgeon removes the degenerated portion of the tendon and any inflamed tissue, then repairs the healthy tendon back to the bone. Sometimes bone spurs are removed if they're contributing to the problem.

The surgery can be done through a traditional open incision or sometimes using minimally invasive techniques. After the procedure, your elbow will be placed in a soft dressing or splint. You'll be able to move your elbow gently right away, though certain movements may be restricted initially to protect the healing tendon.

Recovery

Recovery from surgery requires patience. Physical therapy typically begins within the first few weeks to regain motion in the elbow and prevent stiffness. You'll receive a home exercise program with gentle range of motion exercises initially, progressing to strengthening exercises as healing allows. Most people can manage their recovery with these home exercises, though formal hand therapy is available for those who need additional guidance or develop complications.

Return to light activities usually happens within a few weeks, but full recovery takes several months. Most people can return to normal activities, including sports and heavy work, within three to six months after surgery. Grip strength improves gradually as the tendon heals and you rebuild the muscles around your elbow and forearm.

The success rate for tennis and golfer's elbow surgery is good, with most people experiencing significant pain relief and improved function. However, recovery is slower than many expect, and it's important to follow your surgeon's guidelines to avoid re-injury during the healing process.

When to See a Specialist

If you have elbow pain that's interfering with your work, daily activities, or quality of life, it's worth getting evaluated. While many cases improve with simple modifications, some require more structured treatment. Early intervention can help you get back to normal activities sooner and prevent the condition from becoming chronic.

Dr. Lackey specializes in diagnosing and treating tennis elbow, golfer's elbow, and other tendon conditions. An evaluation can determine the severity of your condition and create a treatment plan tailored to your needs and goals.