Tennis Elbow or Golfer’s Elbow (Epicondylitis)

Overview

Epicondylitis is a painful elbow injury that’s caused by repetitive use of your hand and wrist. It’s often called “tennis elbow” or “golfer’s elbow,” but can be caused by other sports. It’s also a result of overuse of the hand and wrist in the workplace.

It can take weeks to months for the injured tendon to fully heal. Treatment may include:

  • Rest
  • Stretching
  • Over-the-counter pain relievers
  • Physical therapy, elbow strap or brace, and other treatments

Rarely, surgery may be recommended. 

An arm with detailed views of the elbow tendons on the outer area (called the lateral epicondyle).


Types

Epicondylitis can affect 2 different parts of the elbow:

  • Tennis elbow (lateral epicondylitis). It affects the tendons that connect to the bone on the outer elbow.
  • Golfer’s elbow (medial epicondylitis). It affects the inner elbow tendon, and is less common. 

Causes

This injury is a result of overuse of your hand and wrist. Over time, inflammation and tiny tears develop in the tendon that anchors the muscle from your hand to your elbow.

Certain sports and other activities put repeated stress on elbow tendons, such as:

  • Tennis or other racquet sports
  • Golf
  • Baseball and other sports that involve pitching or throwing a ball
  • Jobs that require repeated twisting of the wrist, such as painters, plumbers, cooks, gardeners, carpenters, construction workers, and musicians (drummers and pianists)
  • Excessive use of a computer mouse and keyboard
  • Activities that require you to grip, such as knitting
  • Weight lifting

Other causes can include having:

  • Weak wrists and shoulder muscles
  • Trauma, such as from falling on an outstretched arm or a direct hit to the elbow

This condition can occur at any age. It’s more common in people ages 30 to 50. 

Symptoms

Symptoms develop gradually and worsen over weeks and months. The injury typically affects the dominant arm (the right arm in right-handed people). Symptoms may include:

  • Dull, constant pain or sharp pain in the elbow that may spread to the wrist and hand
  • Weak grip
  • Tenderness on the bony part of elbow
  • Elbow stiffness
  • Numbness or tingling in the elbow that is also felt in 1 or more fingers

Symptoms usually get worse with activities that place stress on the elbow tendon. Even shaking hands or holding a coffee cup may become uncomfortable. 

Diagnosis

To make a diagnosis, we discuss your:

  • Medical history and symptoms
  • Work- and sports-related activities
  • Past injuries to your elbow, neck, or shoulders

We may:

  • Apply pressure to your elbow to assess tenderness.
  • Ask you to move your wrist, elbow, and fingers to evaluate pain and stiffness.

In some cases, we may order imaging tests such as:

  • X-rays to check for arthritis or a fracture.
  • MRI if your symptoms don’t improve after 3 to 6 months of home treatment.
  • Nerve conductions study (NCS) or electromyography (EMG) if you’re having numbness in your arm that doesn’t improve. 

Prevention

To keep your elbow healthy and prevent future injury:

  • Take work breaks, stretch, and relax your hand and wrist.
  • Lift objects with both hands and arms to evenly distribute the weight. Don’t completely fill grocery bags.
  • Avoid repetitive and prolonged forceful gripping. Relax your hand when using a computer mouse. Sharpen kitchen knives to make foods easier to chop. Use a thick-grip pen to write. Wear gloves when using tools.
  • Avoid fully extending and bending your arms, such as when weight-training and lifting objects. Keep the elbow in a partially bent position. Use wrist supports.
  • Use the correct grip technique when playing tennis, golf, and other sports. Use your hips, pelvis, and back. 
  • Take frequent breaks. Stop as soon as you feel elbow pain. Rest can promote healing. 

Treatments and Medications

You may need additional treatment if your symptoms don’t improve with home care.

Most cases of epicondylitis resolve with conservative treatments and time. 

Surgery is rare and considered a last resort. It’s used only if symptoms haven’t improved after at least 6 to 12 months with other treatments.

The type of surgery you have depends on the severity of your injury and overall health. Recovery often takes 4 to 6 months. If needed, we’ll talk about possible risks, such as infection, nerve damage, and loss of strength.

You may return to normal activities when you have:

  • No swelling around the elbow
  • Complete movement of your elbow, wrist, and hand
  • No significant elbow pain when you grip an object, such as a tennis ball

Home Treatment

Epicondylitis can often be effectively treated with home remedies, such as:

  • Rest. Resting your arm is the most important step toward recovery.
  • Ice or cold packs wrapped in a thin cloth and placed on your elbow. Do this for 15 to 20 minutes several times a day for a few days.
  • Over-the-counter pain relievers (such as ibuprofen or naproxen) to control pain and swelling.
  • Elbow strap or brace to reduce pressure on the injured elbow tendon. You may need to wear it for up to 6 weeks. Wear it only during activities that involve repetitive gripping and grasping. Avoid wearing it when your arm is at rest.

Home treatment is often effective within 6 to 12 weeks. Remain patient and stick with treatment until your elbow feels better. In some cases, it may take 6 months or longer for the tendon to heal.

Other Treatment

Rehabilitation exercises can help the elbow tendon heal and prevent further injury. Your physical therapist may teach you exercises to:

  • Stretch the tendons and muscles.
  • Strengthen the elbow tendon by using resistance.
  • Improve flexibility, range-of-motion, and arm strength.

You may experience mild discomfort during these exercises.

To reduce hand and wrist stress:

  • Change how you perform the activity that aggravated the elbow tendon. For example, learn a new tennis or golf stroke technique.
  • Use proper equipment, based on your strength and size.
  • Have an ergonomic specialist, physical therapist, or occupational therapist suggest changes to your workstation. Adjust your chair, desk, and computer, or use job tools differently.

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.