7 Common Tennis Elbow Symptoms You Should Never Ignore

Tennis elbow, medically known as lateral epicondylitis, is a painful condition that affects the outer part of the elbow. Despite its name, this condition doesn’t only affect tennis players—it can occur in anyone who performs repetitive arm and wrist movements. Understanding the symptoms of tennis elbow is crucial for early detection and proper management of this common overuse injury.

This condition develops when the tendons that connect the forearm muscles to the bony prominence on the outside of the elbow become inflamed or damaged. What is tennis elbow exactly? It’s a form of tendonitis in the elbow that results from repetitive stress and strain on the forearm muscles and tendons. The pain typically develops gradually and can significantly impact your daily activities if left unaddressed.

In this comprehensive guide, we’ll explore the seven most common symptoms of tennis elbow, helping you identify whether you might be experiencing this condition and when it’s time to consult a healthcare professional.

1. Pain on the Outer Part of the Elbow

The hallmark symptom of tennis elbow is pain located on the lateral (outer) side of the elbow. This tennis elbow pain typically centers around the bony bump called the lateral epicondyle, where the forearm extensor tendons attach to the bone.

The pain characteristics include:

• Location: Concentrated on the outside of the elbow, sometimes radiating down the forearm toward the wrist
• Onset: Usually develops gradually over weeks or months rather than appearing suddenly
• Intensity: Can range from mild discomfort to severe, sharp pain depending on the severity of the condition
• Duration: May be constant or only appear during specific movements

Initially, you might only notice the pain during specific activities, but as the condition progresses, the discomfort can become more persistent and affect even simple daily tasks. The pain may feel like a burning sensation or a dull ache that intensifies with certain movements.

2. Weakened Grip Strength

One of the most noticeable and functionally limiting symptoms of tennis elbow is a significant decrease in grip strength. This weakness occurs because the damaged tendons cannot effectively transmit force from the forearm muscles to the hand.

You may experience:

• Difficulty holding or gripping objects firmly
• Trouble opening jars, turning doorknobs, or holding a coffee cup
• Weakness when shaking hands with others
• Dropping objects unexpectedly due to insufficient grip
• Inability to carry bags or hold items for extended periods

This grip weakness can be particularly frustrating because it interferes with routine activities that most people take for granted. The weakness is often accompanied by pain when attempting to grip objects, creating a cycle where the affected person avoids using the hand, potentially leading to further muscle weakness and stiffness.

3. Pain When Lifting or Bending the Arm

People with elbow tendonitis often experience increased pain when performing lifting movements or bending the elbow, especially when the palm faces downward. This symptom occurs because these movements activate the affected extensor tendons.

Specific movements that typically trigger pain include:

• Lifting objects: Picking up even lightweight items like a book, phone, or utensils can cause sharp pain
• Carrying items: Holding bags, briefcases, or groceries with the arm extended
• Pouring liquids: Tilting a pitcher or kettle to pour water or beverages
• Using tools: Operating a screwdriver, hammer, or paintbrush
• Extending the wrist: Bending the hand backward at the wrist joint

The pain may start as mild discomfort but can escalate to sharp, intense pain if the activity continues. Rest typically provides some relief, but the pain returns when the triggering activities resume.

4. Tenderness to Touch

Direct pressure on the lateral epicondyle—the bony prominence on the outside of the elbow—causes significant tenderness and pain in people with lateral epicondylitis. This tenderness is often one of the first symptoms that leads people to realize something is wrong.

Characteristics of this tenderness include:

• Sharp or aching pain when touching or pressing on the outer elbow area
• Increased sensitivity even to light pressure
• Pain that may radiate up or down the arm when the area is pressed
• Discomfort when leaning the elbow on hard surfaces like tables or armrests
• Soreness that may worsen after activities involving the arm

This point tenderness is a key diagnostic indicator that healthcare providers use to identify tennis elbow. Even gentle palpation of the affected area can reproduce the pain, helping to distinguish this condition from other elbow problems.

5. Stiffness in the Elbow Joint

Stiffness is a common but often overlooked symptom of tennis elbow. This stiffness typically affects the elbow joint’s range of motion and can make it difficult to fully extend or flex the arm.

The stiffness associated with tendonitis elbow manifests as:

• Morning stiffness: The elbow may feel particularly stiff and tight upon waking, gradually loosening as the day progresses
• Limited range of motion: Difficulty fully straightening or bending the elbow without discomfort
• Tightness in the forearm: A sensation of tension or tightness in the muscles running from the elbow to the wrist
• Post-activity stiffness: Increased rigidity after using the arm repetitively
• Resistance to movement: A feeling that the joint doesn’t move as smoothly or freely as it should

This stiffness occurs due to inflammation in the tendons and surrounding tissues, as well as the body’s natural protective response to injury. Over time, if the condition isn’t addressed, the stiffness can worsen and contribute to decreased flexibility and muscle tightness in the entire arm.

6. Pain That Worsens with Wrist Extension

A distinctive feature of epicondylitis is pain that intensifies when extending the wrist against resistance. This happens because the extensor muscles of the forearm, which attach to the lateral epicondyle, are responsible for wrist extension movements.

You may notice increased pain when:

• Bending your hand backward at the wrist, especially while holding something
• Typing on a keyboard for extended periods
• Using a computer mouse with poor wrist positioning
• Playing musical instruments that require wrist extension
• Performing push-ups or plank exercises
• Engaging in activities that require repetitive wrist movements

Healthcare providers often use a specific test called the “Cozen’s test” or “resisted wrist extension test” to diagnose tennis elbow. During this test, you’re asked to extend your wrist against resistance while the examiner observes whether this movement reproduces your pain. A positive result (increased pain at the lateral epicondyle) strongly suggests tennis elbow.

7. Pain During Twisting Motions

Rotational movements of the forearm, particularly when turning the hand palm-up (supination) or palm-down (pronation), often cause significant discomfort in people with tennis elbow symptoms. These twisting motions engage the affected tendons and can trigger sharp pain.

Common activities that involve painful twisting motions include:

• Turning keys: Unlocking doors or starting a car ignition
• Using hand tools: Operating screwdrivers, wrenches, or pliers
• Opening bottles: Twisting off bottle caps or jar lids
• Wringing out cloths: Squeezing water from towels or cleaning rags
• Playing racquet sports: The backhand stroke in tennis, which involves forearm rotation
• Using kitchen utensils: Stirring with a spoon or flipping with a spatula

The pain during twisting motions occurs because these movements place stress on the already inflamed or damaged extensor tendons. The combination of grip force and rotational movement creates particularly high loads on the lateral epicondyle attachment point, exacerbating the pain and potentially worsening the underlying condition.

Main Causes of Tennis Elbow

Understanding what causes tennis elbow can help in both prevention and management of the condition. While the name suggests a connection to tennis, the reality is that most cases develop from everyday activities rather than sports.

Repetitive Strain and Overuse

The primary cause of lateral epicondylitis is repetitive strain on the forearm extensor muscles and tendons. When these muscles are used repeatedly without adequate rest, microscopic tears develop in the tendon tissue. Over time, these small injuries accumulate, leading to inflammation, pain, and degenerative changes in the tendon.

Occupational Activities

Certain professions and work activities significantly increase the risk of developing tennis elbow:

• Manual labor: Carpenters, plumbers, painters, and construction workers who use hand tools frequently
• Computer work: Extended keyboard and mouse use with poor ergonomics
• Cooking and food preparation: Chefs and food service workers who perform repetitive cutting, stirring, and lifting
• Assembly line work: Workers who perform the same hand motions repeatedly throughout the day
• Gardening and landscaping: Activities involving pruning, raking, and using garden tools

Sports and Recreational Activities

While tennis is the sport most associated with this condition, many other activities can contribute:

• Racquet sports (tennis, squash, badminton) with improper technique or equipment
• Golf, particularly with poor swing mechanics
• Weight lifting and resistance training without proper form
• Throwing sports like baseball or javelin
• Rock climbing and activities requiring sustained grip strength

Age and Degeneration

Tennis elbow most commonly affects adults between 30 and 50 years old. As we age, tendons naturally become less flexible and more prone to injury. The cumulative effect of years of repetitive movements, combined with age-related changes in tendon structure, increases susceptibility to this condition.

Poor Technique or Ergonomics

Using incorrect form during sports or work activities places excessive stress on the elbow tendons. Examples include:

• Incorrect tennis backhand technique
• Improper workstation setup for computer use
• Using tools that are too heavy or poorly designed
• Gripping objects too tightly during activities

Prevention Strategies for Tennis Elbow

While not all cases of elbow tendonitis can be prevented, several strategies can significantly reduce your risk of developing this painful condition:

Strengthen Forearm Muscles

Building strength in the forearm muscles helps them better withstand repetitive stress. Gradual strengthening exercises can condition the muscles and tendons to handle increased loads without injury. However, any exercise program should be started gradually and increased slowly over time.

Improve Technique

Whether you’re playing sports or performing work tasks, proper technique is crucial:

• Take lessons from qualified instructors for sports like tennis or golf
• Ask for ergonomic assessments at work to optimize your workstation setup
• Learn proper body mechanics for lifting and carrying
• Use correct form when exercising or using tools

Use Appropriate Equipment

The right equipment can make a significant difference:

• Sports equipment: Use racquets with appropriate grip size and string tension; consider lighter racquets with larger head sizes
• Work tools: Choose ergonomically designed tools that reduce strain on the forearm
• Computer accessories: Use ergonomic keyboards, mice, and wrist supports
• Protective gear: Consider using counterforce braces during activities that stress the elbow

Take Regular Breaks

Avoiding prolonged repetitive movements is essential for prevention:

• Take frequent breaks during repetitive activities (every 15-30 minutes)
• Alternate tasks to avoid using the same muscles continuously
• Stretch your forearm muscles regularly throughout the day
• Allow adequate rest between intense activities

Warm Up Properly

Before engaging in sports or strenuous activities, prepare your muscles and tendons:

• Perform gentle stretching exercises for the forearm and wrist
• Start activities at low intensity and gradually increase
• Include wrist circles and gentle forearm rotations in your warm-up routine

Maintain Overall Fitness

General physical fitness contributes to injury prevention. Regular exercise, a balanced diet, adequate hydration, and sufficient sleep all support healthy muscles, tendons, and recovery processes.

Listen to Your Body

Pay attention to early warning signs:

• Don’t ignore minor elbow discomfort; address it before it worsens
• Modify or stop activities that cause pain
• Apply ice after activities that stress the elbow
• Seek professional advice if symptoms develop or persist

Frequently Asked Questions

How long does tennis elbow typically last?

Tennis elbow can last anywhere from several weeks to over a year, depending on severity and how well it’s managed. Most cases improve within 6-12 months with appropriate rest and care. Early intervention and avoiding aggravating activities typically lead to faster recovery.

Can tennis elbow heal on its own?

Yes, many mild cases of tennis elbow can heal on their own with adequate rest and avoiding activities that stress the affected tendons. However, without proper modifications to the activities that caused the condition, symptoms often persist or recur. Consulting a healthcare provider can help ensure proper healing and prevent chronic problems.

What’s the difference between tennis elbow and golfer’s elbow?

Tennis elbow (lateral epicondylitis) affects the outside of the elbow where extensor tendons attach, while golfer’s elbow (medial epicondylitis) affects the inside of the elbow where flexor tendons attach. Both involve tendon inflammation but in different locations and affecting different muscle groups. The symptoms and activities that trigger pain differ between the two conditions.

When should I see a doctor for tennis elbow?

You should consult a healthcare provider if your elbow pain persists for more than a few weeks despite rest, if the pain is severe and interfering with daily activities, if you experience weakness or inability to carry objects, or if you have swelling, redness, or fever in the elbow area. Early professional evaluation can prevent the condition from becoming chronic.

Can I continue exercising with tennis elbow?

It depends on the activity and severity of your symptoms. You should avoid exercises that cause pain or stress the affected tendons. Low-impact activities that don’t involve gripping or repetitive arm movements may be acceptable. Always listen to your body—if an activity causes pain, stop and rest. Consult with a healthcare provider or physical therapist for guidance on appropriate exercises during recovery.

Is tennis elbow the same as tendonitis?

Tennis elbow is a specific type of tendonitis. Tendonitis refers to inflammation of any tendon in the body, while tennis elbow specifically refers to tendonitis affecting the extensor tendons that attach to the lateral epicondyle of the elbow. So all cases of tennis elbow involve tendonitis, but not all cases of tendonitis are tennis elbow.

Can poor posture cause tennis elbow?

Yes, poor posture can contribute to tennis elbow development, especially in people who work at computers for extended periods. Slouched posture and improper arm positioning can increase strain on the forearm muscles and tendons, leading to overuse and eventual inflammation. Maintaining good posture and ergonomic workstation setup can help prevent this condition.

Does tennis elbow only affect one arm?

Tennis elbow most commonly affects the dominant arm because it’s used more frequently for repetitive activities. However, it can affect both arms simultaneously or the non-dominant arm alone, depending on the activities performed. People who use both arms equally in their work or sports may develop symptoms in both elbows.

References:

• Mayo Clinic – Tennis Elbow
• Johns Hopkins Medicine – Tennis Elbow (Lateral Epicondylitis)
• American Academy of Orthopaedic Surgeons – Tennis Elbow
• NHS – Tennis Elbow
• WebMD – Tennis Elbow