Painful outside of the elbow when gripping – Tennis Elbow
Tennis elbow, despite its name, isn’t just for tennis players! This common condition causes pain on the outer side of your elbow due to overuse of your forearm muscles. Thankfully, I offer a range of treatments, including cutting-edge therapies, helping you return to your activities pain-free.
Ali Phillips | Hand & Wrist Specialist
Why does my forearm hurt when I grip?
I'm Ali Phillips. If pain on the outside of your elbow is making it hard to lift a cup or turn a doorknob, you may have Tennis Elbow. This guide will help you understand this common condition and learn about modern treatments that can get you back to your life, pain-free.
Book a ConsultationWhat is Tennis Elbow?
Tennis Elbow, also known as lateral epicondylitis, is an overuse injury. It happens when the tendons in your forearm, which connect your muscles to the outside of your elbow, develop tiny tears from repetitive movements. These tendons are responsible for extending your wrist and fingers.
Despite the name, you don't have to play tennis to get it! It's common in anyone who repeatedly uses their forearm muscles for gripping and twisting, from painters and plumbers to office workers and gardeners.
What are the symptoms of Tennis Elbow?
Pain on Outer Elbow
A burning sensation or ache on the bony bump on the outside of your elbow, which may spread down your forearm.
Weak Grip Strength
You might find it difficult to shake hands, hold a coffee cup, or turn a doorknob without pain.
Pain with Twisting
Activities that involve extending your wrist or twisting your forearm often make the pain worse.
Tired of Elbow Pain?
If these symptoms are affecting your daily life, a clear diagnosis is the first step towards a solution. Let's find out what's going on and create a plan to get you back to your activities.
Get a Clear DiagnosisHow will I diagnose your elbow pain?
I can usually diagnose Tennis Elbow just by talking to you and examining your arm. A key test is to check for pain when your wrist muscles are under tension. You can try this gently at home, but stop if it causes sharp pain.
1️⃣
Rest your forearm on a table, with your hand hanging off the edge, palm down.
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With your other hand, gently press down on the back of your affected hand.
3️⃣
Try to lift your wrist upwards against the gentle pressure.
Pain on the outside of your elbow during this movement is a classic sign of Tennis Elbow. An ultrasound scan in the clinic can confirm the diagnosis instantly.
How can I help you get better?
We'll create a personalised treatment plan together. The great news is that surgery is very rarely needed for this condition.
Rest & Physiotherapy The most important first step is to rest the arm and work with a physiotherapist on specific, pain-free exercises to strengthen and stretch the forearm muscles.
Bracing Wearing a Tennis Elbow clasp or brace can help take the pressure off the affected tendon during activities.
Shockwave Therapy This treatment uses sound waves to stimulate healing in the tendon and can be effective for some people.
Steroid Injections These can provide rapid short-term pain relief, but they don't heal the tendon and the pain often returns. I generally advise against them as a long-term solution.
Platelet-Rich Plasma (PRP): A Game-Changer
For persistent Tennis Elbow, PRP therapy is an innovative and highly effective treatment that harnesses your body's own natural healing power. It's a key reason I haven't needed to operate on this condition for over 8 years.
Healing, Not Masking: Unlike a steroid injection that just masks the pain, PRP aims to heal the underlying tendon damage. It uses a concentrated dose of your own platelets, which are rich in growth factors that signal your body to repair and regenerate the torn tissue.
The Process is Simple:
- A small sample of your blood is taken, just like a standard blood test.
- The blood is placed in a centrifuge, a machine that spins it at high speed to separate the components.
- We discard the red blood cells and excess plasma, leaving a small, concentrated amount of platelet-rich plasma.
- Using ultrasound guidance for precision, I inject this "liquid gold" directly into the damaged area of the tendon.
What to Expect: The injection can cause some discomfort for a few days to a week or two, and it's absolutely critical that you rest the arm afterwards. Your body needs time to heal, and doing too much too soon will make the treatment less effective. Pain is your guide: if an activity hurts, your body is telling you to stop.
The Results: The results are not instant, but they are long-lasting. About 90% of my patients need just one injection to achieve significant, permanent relief. Occasionally, a second or third injection may be needed.
Frequently Asked Questions
No, not at all! In fact, most people I see with this condition don't play tennis. It's caused by any repetitive activity that strains the forearm muscles, such as painting, plumbing, carpentry, or even prolonged typing.
Sometimes, with enough rest and by avoiding the aggravating activity, mild cases can improve. However, because it's a degenerative condition (an "osis" not an "itis"), it often requires treatment to properly heal the tendon and prevent it from becoming a chronic problem.
While steroid injections can provide good short-term pain relief by reducing inflammation, they don't address the underlying tendon degeneration. The pain often returns, and there is evidence to suggest that repeated steroid injections can potentially weaken the tendon over time.
PRP uses your body's own natural healing abilities. We take a small sample of your blood, spin it in a centrifuge to concentrate the platelets (which are rich in growth factors), and then inject this "supercharged" plasma directly into the damaged tendon. This stimulates and accelerates the body's natural repair process.
There is some discomfort during the injection, as we can't use too much local anaesthetic because it can interfere with the platelets. However, the procedure is very quick, and most patients tolerate it well. The discomfort subsides rapidly after the injection.
PRP is not a quick fix like a steroid injection; it's designed to promote actual healing. You may not notice a significant change for a few weeks, with gradual improvement continuing over several months as the tendon repairs itself.
While some studies suggest up to three injections, in my experience, the vast majority of patients achieve excellent, long-lasting relief with just a single PRP injection combined with the right physiotherapy programme.
Surgery is very rarely needed, if ever! It would only be considered if your symptoms do not improve after 6-12 months of dedicated non-surgical treatment, including physiotherapy and PRP. Because PRP is so effective, I have not had to perform surgery for tennis elbow in over 8 years.
Prevention is key. This involves using proper technique in sports and activities, ensuring your workspace is ergonomic, regularly performing strengthening and stretching exercises for your forearms, and listening to your body by not pushing through pain.
They are similar overuse conditions but affect different sides of the elbow. Tennis elbow (lateral epicondylitis) causes pain on the outside of the elbow. Golfer's elbow (medial epicondylitis) causes pain on the inside of the elbow.
Test Your Knowledge!
Tennis Elbow FAQs
This is a painful condition possibly caused by overuse and strain of the forearm tendons that attach to the outside (lateral) part of the elbow.
No, while common in tennis players, various activities that involve repetitive wrist and forearm use can cause it. Examples include other sports, occupations like plumbing, painting, or computer work. Only 7% of people with tennis elbow played tennis regularly!
I can diagnose it through a examination and your medical history. Imaging tests (X-ray, ultrasound, MRI) are rarely needed but can aid in ruling out other issues.
Avoiding painful stimuli: This is absolutely critical to you getting better exclamation month let your body heal and listen to the pain. it is telling you to stop.
- Ice: Apply ice packs several times a day.
- NSAIDs: Over-the-counter pain medications (ibuprofen, naproxen).
- Counterforce Bracing: A forearm strap (clasp) might lessen strain on tendons.
- Physiotherapy: Specialised exercises strengthen forearm muscles and promote tendon healing. There are lots of physiotherapy videos online about eccentric stretching exercises but no exercises should cause pain.
- Corticosteroid Injections: Short-term relief, should be used with caution. Most elbow surgeons come I like me would suggest steroid injections only to get you through an acute episode like an important contract or a wedding for example. It does not alter the Natural History and can make surgery less effective.
PRP injections: I have not had to operate on tennis elbow since using PRP. it is covered by most insurance policies. The platelet rich plasma helps to heal the problem instead of just masking it like corticosteroid. See my information leaflet on PRP here.
Surgery is a rare option reserved for patients unresponsive to at least 6-12 months of nonsurgical treatment combined with significant impact on daily life.
Several surgical techniques exist. It usually involves either release or repair of the affected tendon. I do these under local anesthetic as a day case but, as I mentioned above, I have not had to do this for a six years since using PRP.
Surgery is very successful in relieving pain for most. However, recovery and rehabilitation involve commitment to regaining lost strength and range of motion.
Yes, most cases resolve with time and conservative measures. Recovery may take weeks to many months.
If ignored, inflammation could worsen, causing increased pain and greater functional limitation. However, severe long-term consequences are uncommon.
Healing time varies widely. Often, a few weeks of initial rest combined with treatment aids improvement. For some, a few months to over a year may be needed for complete recovery.
During the initial painful phase, rest is important. Later, specific exercises guided by a physio- or hand therapist play a crucial role in rehabilitation.
Certain massage techniques may offer some relief and promote healing. It’s best to consult a massage therapist experienced in treating musculoskeletal injuries.
In the acute (early, painful) stages, ice is preferable for reducing inflammation. With your physiotherapist’s guidance, alternating or utilising heat later may support healing.
Short-term brace use for pain relief can be beneficial. However, relying on them heavily for an extended period could weaken muscles and delay recovery.
Research supporting other therapies is limited. Some include:
- Platelet-rich plasma (PRP) injections: see above
- Shockwave therapy: Some benefits in short-term studies, but more research is needed.
This idea is not supported by medical evidence.
It’s possible and can happen with frequent strain of both arms. Consult a doctor for an accurate diagnosis and tailored treatment plan.
Your doctor, physical/hand therapist are prime sources. There is an information leaflet in my patient information section.
