Tennis Elbow (Lateral Epicondylitis): Causes, Symptoms, and Effective Treatments
Published on 2026-05-21
Lateral Epicondylitis: Tennis Elbow Explained by a Specialist
Lateral epicondylitis, commonly called "tennis elbow," is a tendinopathy affecting the extensor tendons of the forearm at the level of the lateral epicondyle of the elbow. Despite its name, it affects both athletes and people with repetitive manual professions.
Mechanism and Causes
Epicondylitis is an overuse pathology: repeated microtrauma to the tendon of the extensor carpi radialis brevis and the common extensor digitorum leads to tendon degeneration (tendinopathy) rather than acute inflammation. Main causes include:
- Repetitive wrist extension movements (tennis, badminton, squash)
- Manual work with repeated movements (painting, carpentry, gardening)
- Intensive use of vibrating tools or computer mouse
- Rotator cuff muscle weakness (biomechanical imbalance in the kinetic chain)
Symptoms
- Pain on the outer side of the elbow, sometimes radiating toward the forearm
- Pain worsened by gripping, twisting (turning a doorknob, turning a key)
- Tenderness on palpation of the lateral epicondyle
- Decreased grip strength
- Pain during resisted wrist extension (Cozen's test)
Conservative Treatment
- Relative rest and avoidance of painful movements
- Resting splint or anti-epicondylitis orthosis (strap)
- Ice after activities
- Eccentric wrist stretching: the foundation of rehabilitation
- Physiotherapy: deep transverse massage, radial shock wave therapy
Ultrasound-Guided Treatments
Cortisone infiltration: rapid action, reduces pain and inflammation within 48 hours. Effect lasts 4 to 8 weeks. Useful for acute flare-ups but does not treat the underlying tendinopathy.
PRP (Platelet-Rich Plasma) infiltration: the treatment of choice for chronic epicondylitis. PRP stimulates tendon regeneration by releasing growth factors. Results appear from 4 to 6 weeks and continue to improve up to 6 to 12 months. Scientific studies show 70 to 80% improvement at 2 years.
Fenestration (dry needling): performed under ultrasound guidance, multiple perforations of the tendon are made with a fine needle to stimulate the healing process.
Frequently Asked Questions
Does tennis elbow only affect tennis players?
No, only 5 to 10% of cases involve tennis players. Epicondylitis affects all people performing repetitive wrist extension movements: craftsmen, musicians, computer workers, gardeners, etc.
What is the difference between cortisone and PRP infiltration for epicondylitis?
Cortisone provides rapid but temporary relief (4 to 8 weeks) and does not treat the underlying tendon degeneration. PRP stimulates tendon repair and provides lasting results (12 to 24 months), with superior long-term efficacy demonstrated.
Are eccentric exercises really effective?
Yes, eccentric wrist extension exercises (such as the Tyler et al. protocol) are the cornerstone of conservative treatment. They strengthen the tendon by lengthening it under tension, which promotes collagen fiber regeneration.
How long does it take to heal tennis elbow?
With appropriate treatment combining physiotherapy and PRP infiltration, most patients notice significant improvement in 6 to 12 weeks. Without treatment, spontaneous healing may take 12 to 18 months.