Tennis elbow (epicondylitis): why it hurts and how it is treated without surgery

«My elbow hurts when I pick up a frying pan, when I turn the car key or even when I shake hands». It's one of the most frequent reasons people come to see me, and it's almost always the same thing: epicondylitis, better known as tennis elbow. And it's almost never caused by tennis.

What tennis elbow actually is

On the outer side of the elbow (the epicondyle) sit the anchor points of the tendons of the muscles that extend the wrist and fingers. When those tendons are overloaded by repeated movements, that anchor point becomes irritated and damaged. That's why it hurts exactly there, on the bony prominence on the outside of the elbow, and why the pain increases when you grip or lift weight with the palm facing down.

There's one thing that's important to understand: we now know that, rather than inflammation, it's usually a degeneration of the tendon caused by overuse (what we call tendinosis). That explains why complete rest doesn't cure it: the tendon doesn't just need to rest, it needs to regain strength gradually.

Why it appears

• Repeated movements: mouse and keyboard, tools, cooking, hairdressing, cleaning…
• A one-off overload: a weekend of DIY, painting the house, pruning.
• Poor technique or unsuitable equipment in those who do play racket sports or padel.
• Weakness in the forearm and shoulder, which makes the elbow take more than its share.

First of all: confirming the diagnosis

Pain on the outer side of the elbow is almost always epicondylitis, but not always. With musculoskeletal ultrasound in the consultation itself I can see the state of the tendon, whether there is degeneration or small tears, and rule out other causes (such as a trapped nerve in the forearm, which gets confused with epicondylitis and is treated differently). Getting this right avoids months of the wrong treatment.

The treatment that really works

The great majority of cases of epicondylitis resolve without surgery. These are the cornerstones, in order:

1. Exercise: the foundation of treatment

Progressive strengthening of the tendon —above all eccentric work— is what has the most scientific backing and what genuinely cures it. It has to be done properly and consistently. In clinic I explain step by step which exercises suit your elbow and how to progress with them.

🎾 Read more about elbow and wrist pain

2. Modifying the load (not complete rest)

This means temporarily reducing the movements that hurt most and correcting your ergonomics (your workstation, the tool, your sporting technique), not stopping moving the arm. An epicondylitis strap can help now and then during the moments of heaviest load.

3. Ultrasound-guided injections and PRP

When the pain persists despite several months of well-performed exercise, I consider ultrasound-guided treatments. In chronic epicondylitis, PRP (platelet-rich plasma) is of particular interest, because it aims to support the repair of the degenerated tendon rather than simply «switching off» the pain. If there is an associated trapped nerve, ultrasound-guided hydrodissection may be the solution.

The most common mistake

Thinking that «it'll go away on its own with rest». Sometimes it settles for a while, but when you go back to your activity it returns, because the tendon is still weak. Epicondylitis isn't cured by resting, it's cured by strengthening. The sooner the right work is started, the sooner it resolves and the lower the risk of it becoming chronic.