Lateral epicondylitis or “tennis elbow”

The main symptoms of lateral epicondylitis are:

• pain on the outside of the elbow, often clearly localized;
• discomfort that appears gradually, without any obvious triggering trauma;
• increased pain during certain movements (grasping an object, rotating the forearm, extending the wrist);
• possible radiation to the forearm;
• in some cases, pain that persists at night or at rest.

The intensity of the symptoms can vary from simple temporary discomfort to chronic pain that limits everyday movements, such as carrying a bag, shaking hands, or lifting a cup.

Lateral epicondylitis is caused by repeated microtrauma to the extensor tendons of the forearm. Due to repeated use, these tendons develop poorly healed micro-tears, causing a change in their structure. This is not a classic inflammation, but a process of tendon degeneration. This phenomenon develops gradually and can last for several months or years

Certain factors increase the risk of developing epicondylitis:

The diagnosis is based primarily on:
A medical interview to gather information about risky activities or repetitive movements that could be causing the pain.
Palpation, with pain localized on the outer part of the elbow.
Specific tests that reproduce the pain by contracting or stretching the muscle group concerned.

In case of doubt or if symptoms persist despite treatment (see below), additional tests may be requested:

• Ultrasound: shows the condition of the tendon, useful for follow-up.
• X-ray: to look for calcifications or associated osteoarthritis.
• MRI: reserved for severe or chronic forms, it allows for a detailed analysis of the tendons, ligaments, and joint.

Conservative treatment

In the vast majority of cases, the first option offered is conservative treatment, i.e., treatment that does not require surgery. This treatment may include:

• Relative rest of the arm, without complete immobilization.
• Adaptation of certain movements and ergonomic advice (e.g., adaptation of posture and work equipment).
• Physiotherapy: stretching, muscle strengthening, shock wave therapy, or dry needling (a technique that involves inserting fine needles into muscle points to relieve pain and release tension).
• Anti-inflammatory drugs, taken orally or applied locally.
• Orthotics, support bands, or epicondylar bracelets.

It should be noted that even without medication or surgery, lateral epicondylitis generally progresses favorably (see “Progression and possible complications”).

Injections

An injection is administered into a joint, tendon, or around a nerve. In the case of lateral epicondylitis, injections may be necessary if rehabilitation is impossible or if the pain is very severe.

• Corticosteroid injections: provide rapid pain relief, but with a high risk of recurrence in the medium term and possible side effects (tendon damage, skin discoloration).
• PRP (platelet-rich plasma) injections: a more recent alternative aimed at stimulating tendon healing, with no major side effects, but the costs are not covered by basic insurance.

Surgery

Surgery is only considered as a last resort, when the pain is debilitating and other treatments have proven ineffective.

Two surgical techniques may be offered:

• Open surgery: a traditional technique performed under general anesthesia, involving a small incision in the elbow to directly access the painful area.
• Arthroscopic surgery: a less invasive technique. The surgeon inserts a camera and small instruments into the joint through small incisions. This technique often allows for a shorter recovery time and less scarring.

Both methods give good results in the long term. Post-operative rehabilitation is generally quick and functional, meaning that no immobilization is necessary and the patient can begin to move their arm within the first few days after the procedure.

The natural progression of lateral epicondylitis is spontaneously favorable: more than 90% of patients recover within a year without surgery. However, approximately 20% of patients may experience prolonged pain (more than 3 years), and approximately 10% of people with persistent pain require surgery. Once lateral epicondylitis has healed, the recurrence rate is low (less than 10%). It is important to note that repeated cortisone injections increase the risk of complications and rebound effect (return of symptoms after temporary improvement)

A few simple steps can help protect the elbow and prevent lateral epicondylitis:

• Use appropriate work or sports equipment (e.g., a good tennis racket with a suitable handle diameter, ensure that your computer workstation is ergonomic with a suitable chair and forearm supports or a vertical mouse, etc.).
• Warm up properly before any physical activity.
• Strengthen your forearm muscles.
• Correct poor working posture

It is advisable to make a doctor's appointment if:

• the pain has lasted for several weeks without improvement;
• the pain interferes with your daily activities or sleep;
• you have previously had injections or surgery on your elbow;
• you have associated symptoms: numbness, muscle weakness, limited movement.

Can I get tennis elbow even if I don't play tennis?
Yes. Despite its name, tennis elbow does not only affect tennis players. Most cases are caused by repetitive movements that put excessive strain on the muscles and tendons of the forearm, often in a professional context (manual labor, prolonged office work, etc.) or during other physical activities. A blow or trauma to the elbow can also be the cause.

Can tennis elbow be cured?
Yes, in the vast majority of cases, tennis elbow heals spontaneously within a few months. When treatment is necessary (such as physical therapy, injections, or, more rarely, surgery), the outcome is generally favorable and recurrences are rare.

Does tennis elbow always require surgery?
No, surgery is only considered as a last resort. It is reserved for chronic and painful cases, when other treatments have not worked. In the vast majority of cases, tennis elbow heals spontaneously within a few months.

What is the difference between tennis elbow and golfer's elbow?
Tennis elbow (lateral epicondylitis) causes pain on the outside of the elbow, while golfer's elbow (medial epicondylitis) causes pain on the inside. Both conditions are caused by overuse of the forearm tendons, but they affect different areas and muscle groups.