Tennis elbow, known medically as lateral epicondylitis, is an overuse condition that causes pain on the outer side of the elbow. Despite the name, most people who develop it have never played tennis. Golfers elbow is seldom seen in golfers and occurs on the inside of the elbow.

The condition affects the tendons that anchor the forearm's wrist-extensor/flexor muscles to a bony bump on the outer/inner elbow called the lateral/medial epicondyle. Although the "-itis" in the name implies inflammation, research has shown that the underlying problem is primarily tendon degeneration and microscopic tearing rather than active inflammation, which is why physicians increasingly describe it as a tendinopathy. This is also why rest alone is often not enough and why treatment focuses on restoring healthy tendon tissue.

Tennis/Golfer elbow develops from repetitive strain, typically involving repeated wrist motion and forceful gripping. Over time, these small, repeated stresses outpace the tendon's ability to repair itself. It is most common in adults between roughly 30 and 50 years old and affects men and women at similar rates. Because it is driven by repetitive hand and wrist use, it is frequently seen in people whose work or hobbies involve gripping or repetitive motion, including painters, plumbers, carpenters, mechanics, butchers, cooks, musicians, and office workers who spend long hours typing or using a computer mouse. Tennis players and golfers, in fact, make up only a small share of those affected.

The most prominent symptom of tennis elbow / golfers elbow is pain on the outer / inner side of the elbow, which often extends into the forearm and worsens with gripping, lifting, and twisting motions.

Common symptoms include:

• Pain and tenderness on the outer / inner elbow, centered over the lateral / medial epicondyle

• Aching or burning in the forearm muscles, which may radiate from the elbow toward the wrist

• Difficulty lifting or gripping, such as picking up a cup, turning a doorknob, or shaking hands

• A weakened or unreliable grip, especially during repetitive or sustained activity

Symptoms usually build gradually over weeks rather than appearing suddenly, and they often flare with the specific motions that triggered the condition.

Tennis / Golfers elbow is usually diagnosed through a clinical evaluation, and most cases are successfully managed without surgery.

Dr. Cohen diagnoses lateral / medial epicondylitis primarily through a careful history and physical examination, locating the point of tenderness over the lateral epicondyle and performing gentle maneuvers that reproduce the pain with resisted wrist and finger motion. Imaging is not always necessary, but X-rays may be used to rule out arthritis or other bony causes, and ultrasound or MRI may be used in select cases or when symptoms do not respond to initial treatment.

Most cases do not require surgery. The majority of Dr. Cohen's patients improve with a course of nonsurgical care, which may include:

• Splinting or bracing, including a counterforce brace worn on the forearm to reduce strain on the tendon

• Physical or occupational therapy, focused on stretching and progressive strengthening of the forearm muscles

• Injections, used in selected cases to help manage persistent pain

• Medications, such as natural anti-inflammatory supplements, to relieve discomfort during recovery

Because tennis / golfers elbow involves slow-healing tendon tissue, recovery can take time, and consistency with treatment is important. Nonsurgical care is highly effective in most cases. When a well-directed course of nonsurgical treatment does not relieve symptoms, Dr. Cohen will discuss surgical options to address the damaged tendon. The right approach depends on the severity and duration of your symptoms, which is why an individualized evaluation is the best place to start.