Tennis elbow
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026Tennis elbow is a common, painful condition affecting the tendons on the outside of the elbow. It is caused by gradual wear and a failed healing response in the tendon rather than by true inflammation.
📊 Tennis elbow affects roughly 1-3% of adults and is the most common cause of elbow pain seen by GPs. Despite the name, only about 5-10% of cases occur in tennis players.
What is tennis elbow?
Tennis elbow affects the tendons that attach to the bony bump on the outside of the elbow - the tendons that pull the wrist and fingers back. Rather than ordinary inflammation, the problem is a gradual breakdown of the tendon, where the body has tried but failed to repair small areas of damage. This is why anti-inflammatory treatments tend to give only limited, short-term relief.
The condition usually develops from repeated gripping and wrist movements that overload these tendons. Small areas of damage build up faster than the tendon can heal, and over time it weakens. Heavy manual work, typing, racket sports, gardening and DIY are common triggers, though in many people it comes on gradually with no obvious cause.
A few other problems can cause pain on the outside of the elbow, such as irritation of a nearby nerve (radial tunnel syndrome) or a ligament or joint issue. These are treated differently, so your clinician will check for them during the examination. Occasionally a nerve test is arranged if there is tingling or numbness as well as pain.
Common causes
- Repetitive wrist extension and gripping activities
- Heavy manual labour
- Racket sports (particularly backhand strokes)
- Computer and keyboard work
- Gardening and DIY activities
- Sudden increase in activity or change in technique
Who is at risk? Age 35-55, manual occupations, and dominant arm use are the main risk factors. Smoking and obesity are associated with poorer outcomes.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Pain and tenderness on the outside of the elbow, over the bony bump
- Pain spreading down the forearm when gripping or lifting
- Weak grip and a tendency to drop things
- Difficulty with everyday tasks such as shaking hands, lifting a kettle, or turning a door handle
- Pain made worse by bending the wrist or fingers back against resistance, especially with the elbow straight
When to seek help: Most cases resolve within 12-18 months with appropriate management. See your GP or physiotherapist if pain is severe, limiting work or daily activities, or has not improved after 6-8 weeks of self-management.
How is it diagnosed?
Your surgeon will take a detailed history and examine the joint. The following investigations may be arranged to confirm the diagnosis:
- Diagnosed by history and examination - specific movements that load the tendon reproduce the pain
- Ultrasound - can show changes in the tendon and help guide an injection if needed
- MRI - used in unusual cases or before surgery to check the tendon
- Nerve tests - only if a nerve problem is suspected
Scans are not needed to make the diagnosis, but can be helpful if things are unclear or before surgery is considered.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Physiotherapy and load management
Targeted strengthening exercises for the wrist and forearm tendons are the cornerstone of treatment, building the tendon back up with gradually increasing load. A forearm support strap can ease the strain during activity, and adjusting the tasks that aggravate it is important. Expect around 3-6 months for a meaningful improvement.
Extracorporeal shockwave therapy (ESWT)
Shockwave therapy uses focused sound waves applied to the tendon over several sessions (typically 3-6). It may help some people whose symptoms have not settled with physiotherapy, but the evidence is mixed and the amount of benefit varies a lot from person to person. NICE considers it safe enough to offer, though it does not work for everyone - it is best thought of as one option to discuss rather than a guaranteed fix.
Platelet-rich plasma (PRP) injection
Autologous PRP contains growth factors that promote tendon healing. Injected under ultrasound guidance directly into the area of degeneration. Growing evidence base showing benefit over corticosteroid injection at 6 months. Not universally available on the NHS.
Surgical debridement and release
The worn, degenerate tendon tissue on the outside of the elbow is cleared away and the tendon origin is released, done either with keyhole surgery or through a small open incision. It is reserved for people with more than 6-12 months of symptoms that have not settled with physiotherapy and other non-surgical measures.
Recovery
The majority of patients with tennis elbow recover with non-operative treatment over 12-18 months. Corticosteroid injections are not recommended, as the evidence shows they give short-term relief but worse long-term outcomes than physiotherapy alone, with higher recurrence rates. Shockwave therapy is one option that may be considered if physiotherapy has not helped, although its benefit varies between individuals.
- Physiotherapy programme: 3-6 months
- Shockwave therapy: 3-6 sessions over 6-12 weeks
- Natural history: 80% resolve within 12-18 months
- After surgery: 3-6 months rehabilitation
What results can I expect?
Over 80% of patients recover within 12-18 months. Surgical outcomes are good in carefully selected patients, with 85-90% reporting significant improvement. A minority develop chronic refractory tennis elbow that is difficult to treat.
Tennis elbow - why rest alone is not enough
Common activity questions for this condition. Timelines are approximate, always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Drive | When comfortable | When gripping the steering wheel is pain-free. May be days to weeks depending on severity. |
| Return to desk work | Immediately | May need ergonomic adjustments, keyboard height, mouse, wrist position. Discuss with physio. |
| Manual work / gripping | Months 2–6 | Gradual return guided by symptoms. Sudden increase in gripping tasks causes flare-ups. |
| Tennis / racket sport | Months 3–6 | With technique review and brace. Gradual return, volume before intensity. |
| Gym (upper body) | Months 2–4 | Avoid wrist extension loading until tendon has settled. Lower body gym from day 1. |
| Full sport | Months 6–12 | 80% of patients recover fully within 12–18 months with correct rehabilitation. |
Common concerns during recovery, and whether they are expected.
Your questions, answered
Plain-English answers to the things people most often ask, drawn from real patient questions and grounded in published guidance. Tap a question to open it.
About thisWhat is tennis elbow?
It is pain on the outer side of the elbow from overload of the tendons that straighten the wrist. Most cases are not caused by tennis, but by repetitive gripping or lifting.
Your choiceHow is it treated, and will it settle?
Most cases improve with time. First-line care is adjusting the activities that aggravate it and a progressive tendon-loading exercise programme. The large majority recover without surgery, although it can take many months.
InjectionsDo steroid injections help?
A steroid injection can reduce pain in the short term, but the evidence shows worse longer-term outcomes and higher recurrence compared with exercise or simply waiting. Many clinicians now avoid routine steroid injections and favour exercise.
Self-careWhat can I do day to day?
Adjust gripping and lifting, check your technique and equipment, consider a forearm brace for aggravating activities, and follow a graded strengthening programme. Simple pain relief can help.
Getting backHow long does it take?
Often several months. Continuing gentle use within comfort, rather than resting completely, tends to recover better.
UrgentWhen should I seek review?
Pain that followed a clear injury, significant weakness, locking of the elbow, or numbness and tingling into the hand, which may point to nerve involvement rather than tennis elbow.
WellbeingIt is frustrating that it is taking so long.
Tendon problems are slow to settle, which is normal. Consistency with the exercises and realistic expectations make a big difference.
- British Elbow & Shoulder Society: Tennis elbow
- NICE CKS: Tennis elbow (clinical knowledge summary)
- Versus Arthritis: Elbow pain
- British Elbow & Shoulder Society: Exercises for elbow stiffness
These links are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.
Preparing for surgery?
Read our step-by-step guide - what to expect before, during, and after your procedure.
How is it diagnosed?
- ✓Diagnosed by history and examination - specific movements that load the tendon reproduce the pain
- ✓Ultrasound - can show changes in the tendon and help guide an injection if needed
- ✓MRI - used in unusual cases or before surgery to check the tendon
- ✓Nerve tests - only if a nerve problem is suspected
Recovery milestones
- ●Physiotherapy programme: 3-6 months
- ●Shockwave therapy: 3-6 sessions over 6-12 weeks
- ●Natural history: 80% resolve within 12-18 months
- ●After surgery: 3-6 months rehabilitation