Tennis elbow usually improves without surgery. Early care commonly involves modifying the load that aggravates the tendon, staying active within tolerable limits and following a progressive exercise program. An orthopaedic opinion is generally considered when the diagnosis is uncertain or substantial pain and loss of function persist despite a well-performed period of non-surgical treatment.
Seek earlier medical assessment if elbow pain followed a significant injury, the joint looks deformed, the arm or fingers change colour, sensation changes, swelling is unusual, or redness and heat occur with fever. These features are not typical of uncomplicated tennis elbow.
This article provides general information and does not replace an individual assessment by a qualified health professional.
What is tennis elbow?
Tennis elbow is pain arising from the tendons that attach the forearm muscles to the outside of the elbow. Its medical name is lateral elbow tendinopathy or lateral epicondylalgia. It is linked to repeated or excessive loading of the wrist and forearm, not only to playing tennis.
Common triggers include racquet sports, gym training, using tools, lifting with the palm down, repetitive gripping and some computer or manual work. The tendon can become painful when the load placed on it exceeds its current capacity to recover.
What are the usual symptoms?
- pain or tenderness over the bony area on the outside of the elbow
- pain extending into the upper forearm
- pain with gripping, lifting, shaking hands or turning a doorknob
- reduced grip strength because gripping is painful
- symptoms that increase after repeated wrist or forearm activity
Symptoms may develop gradually or start after a sudden increase in activity. The elbow joint itself may still move normally.
What else can cause pain on the outside of the elbow?
Lateral elbow pain is not always tennis elbow. Other possible causes include:
- radial nerve irritation
- pain referred from the neck
- elbow arthritis or joint injury
- ligament injury or instability
- fracture after trauma
- another tendon condition
A clinician should reconsider the diagnosis when symptoms include prominent numbness, neck pain, locking, marked loss of movement, instability, or pain that does not follow the expected pattern.
Who should you see first?
A GP or physiotherapist is usually a suitable first contact. A GP can assess whether another medical condition or injury is possible, advise on medicines and arrange referral if needed. A physiotherapist can measure strength, function and aggravating loads and build an exercise plan.
A sports physician may be useful when diagnosis, load management, work or sports participation is complex. An orthopaedic elbow surgeon is most relevant when there is a possible structural problem requiring surgical assessment or symptoms remain substantially disabling after suitable non-surgical care.
How is tennis elbow diagnosed?
Diagnosis is usually clinical. The clinician asks about work, sport, onset and aggravating movements, then examines the elbow, wrist, neck, nerve function and grip. Pain reproduced by loading the wrist extensor muscles can support the diagnosis.
Healthdirect notes that X-ray, ultrasound or MRI may sometimes be used, but routine imaging is not necessary for every case. Imaging is more useful when the diagnosis is unclear, there was trauma, movement is restricted, another condition is suspected or surgery is being considered.
What treatments are usually tried before surgery?
Modify the aggravating load
Temporarily reduce or change the tasks that provoke a strong or lasting increase in symptoms. This may mean adjusting grip, tool size, racquet setup, lifting technique, work breaks or training volume. Complete rest can reduce capacity, so the aim is usually to find a manageable level of activity rather than stop using the arm indefinitely.
Progressive exercise
The 2022 lateral elbow pain clinical practice guideline supports resisted exercise for the wrist extensor muscles as part of care. A program may also address grip, shoulder strength and the movements required for work or sport. Loading should be progressed according to symptoms and function rather than copied from a generic timetable.
Manual therapy and education
Manual therapy may provide short-term pain relief for some people and can be combined with exercise. Education helps set expectations: tendon recovery is often gradual, and a temporary flare does not automatically mean new tissue damage.
Brace or strap
A forearm strap or wrist support can reduce symptoms during selected activities for some people. It is an optional aid, not a cure, and should not replace progressive rehabilitation.
Pain relief
Discuss medicines with a doctor or pharmacist. Suitability depends on other conditions, pregnancy, allergies and current medicines. Pain relief can help activity, but it does not by itself restore tendon capacity.
What about injections?
Different injections are offered for tennis elbow, including corticosteroid and platelet-rich plasma. Their effects, time course, cost and evidence are not the same. The decision should not be based on a claim that one injection regenerates the tendon or guarantees faster recovery.
Corticosteroid injection may provide short-term relief for some people, but symptom relief does not necessarily mean that the tendon is ready for unrestricted load. Ask about expected duration of benefit, recurrence, risks and how the injection would fit with rehabilitation.
For platelet-rich plasma and other injections, ask whether the proposed benefit is supported for your specific diagnosis, what alternatives exist and whether you will still need a graded exercise program. A second opinion can be reasonable before paying for a procedure with uncertain benefit.
How long does tennis elbow take to improve?
Recovery varies. Healthdirect advises that tennis elbow often settles on its own and reports that about nine in ten people heal within a year without surgery. Symptoms may still take longer in some people, particularly when high-load work continues, the diagnosis is different, or rehabilitation has not addressed the relevant tasks.
Progress is better judged by changes in grip, work tolerance, exercise load and daily function than by pain on a single day. If the condition is not improving, the plan and diagnosis should be reviewed rather than simply repeated.
When should an orthopaedic surgeon assess tennis elbow?
Surgery is rarely needed. A surgical opinion may be appropriate when:
- substantial pain and functional loss persist despite a structured treatment program
- the diagnosis remains uncertain
- there is marked loss of movement, instability, locking or another joint problem
- imaging identifies an associated injury that may need operative treatment
- symptoms prevent essential work or daily tasks after reasonable alternatives have been tried
You can compare elbow surgeons in Perth by their documented clinical focus and locations. For a sport-related condition, the sports orthopaedic surgeon directory for Perth may also be relevant.
What does tennis elbow surgery involve?
Operations generally remove or release damaged tendon tissue at the outer elbow and may address another problem found in or around the joint. Surgery can be open or arthroscopic, depending on the surgeon's assessment and the condition being treated.
Possible risks include infection, nerve injury, stiffness, reduced grip, persistent pain and failure to return to the desired activity. Rehabilitation is still required after surgery. Ask why surgery is expected to help your particular symptoms and what evidence supports the proposed approach.
Questions to ask before treatment
- What findings support the diagnosis of tennis elbow?
- Could the neck, a nerve or the elbow joint be contributing?
- Which activities should I modify, and which should I continue?
- What should my exercise program progress towards?
- How will we measure whether treatment is working?
- What are the short- and long-term effects of an injection?
- Why might surgery help, and what are the alternatives?
When does elbow pain need prompt care?
See a clinician promptly when pain is worsening, swelling is abnormal, sensation changes, or the arm or fingers turn blue or white. Redness, heat and fever can indicate infection and need urgent assessment. After a fall or impact, severe pain, deformity or inability to use the arm may indicate fracture or dislocation.
Call triple zero (000) for a serious emergency. For health advice when you are unsure what to do, call healthdirect on 1800 022 222.
Do you need a referral?
A valid referral is generally required to claim the relevant Medicare specialist benefit. Your GP can include the symptom duration, effect on work and function, examination findings, treatment completed and relevant imaging. See how to get an orthopaedic referral in Australia.
Frequently asked questions
Do you need to play tennis to get tennis elbow?
No. Any repeated or excessive wrist and forearm loading can contribute. Tool use, lifting, manual work, gym training and other racquet sports are common examples.
Should you completely rest tennis elbow?
Usually not for an extended period. Temporarily reduce provocative loads, then rebuild capacity progressively. A clinician can help find a level of activity that does not cause a substantial lasting flare.
Is tennis elbow inflammation?
The condition is better described as tendinopathy. In persistent cases, tendon degeneration and failed adaptation may be more important than active inflammation alone.
When is surgery considered?
Usually only after substantial symptoms continue despite appropriate non-surgical care, or when assessment identifies another structural problem. Surgery is not the normal first treatment.