Tennis elbow (lateral epicondylitis)

What is tennis elbow?

Tennis elbow is not an acute inflammation in the classic sense, but predominantly an overload reaction with microscopic changes (tendinosis) of the tendon fibers, especially the tendon of the extensor carpi radialis brevis (ECRB) muscle. Typically, there are tender points over the lateral epicondyle and pain when gripping and extending the wrist.

• Synonyms: Lateral epicondylitis, epicondylitis humeri radialis, tennis elbow
• Common: 1–3% of adults, peak in middle age
• Most of the time it can be controlled conservatively, patience and stress control are key

Anatomy and function

The extensor muscles of the forearm arise from the lateral epicondyle of the humerus. The common extensor origin involving the ECRB is particularly relevant. These muscles extend the wrist and fingers and stabilize the grip.

• Affected structure: tendon insertion of the forearm extensors (especially ECRB)
• Pain location: outside of the elbow, sometimes radiating to the forearm
• Provocation: Wrist extension against resistance, strong grip, turning

Causes and risk factors

The trigger is usually repetitive strain on the forearm extensors, which puts too much strain on the tendon. Rarely is there an underlying acute event. Individual factors can make the tendon more vulnerable.

• Monotonous activities: mouse/keyboard, screws, hammering, tweezers
• Sports: racket sports, but also climbing, weight lifting, rowing
• Technology/Ergonomics: Unfavorable grip technique, hard racket tension, lack of forearm support at the workplace
• Risk factors: lack of breaks, sudden increases in stress, previous tendon problems, smoking

Symptoms and course

• Tenderness on the outer elbow (point above the lateral epicondyle)
• Pain when extending the wrist/rotating the forearm, weakness when grasping
• Start-up pain, later pain on exertion and possibly at rest
• Everyday problems: lifting a coffee cup, operating a door handle, typing, holding tools

If left untreated, the symptoms can last weeks to months. With targeted therapy and adjustment of the load, most cases improve significantly within 6-12 months.

Diagnosis in practice

The diagnosis is clinical. The anamnesis and examination findings are crucial. Imaging is used to rule out other causes and to plan therapy.

• Examination: tenderness over the lateral epicondyle, pain on Cozen, Maudsley and Thomsen tests
• Function: grip strength, mobility, short neurological tests
• Ultrasound: assessment of the tendon structure (thickening, hypoechogenicity, Doppler signal), exclusion of tears
• X-ray: if bony changes, osteoarthritis or calcifications are suspected
• MRI: rare, in cases of unclear or treatment-refractory disease

Conservative treatment – ​​first and according to guidelines

The vast majority of tennis elbows are successfully treated without surgery. The aim is to adapt the load to the stimulus, reduce pain and gradually rebuild tendon function.

• Stress control: adapting pain-causing activities, taking breaks, reducing speed, optimizing technique
• Pain therapy: temporary NSAIDs locally or systemically; Cold/heat as tolerated
• Orthosis/epicondylitis brace: pressure relief at the tendon base during stress phases
• Physiotherapy: eccentric/concentric-eccentric training of the extensors, stretching, manual therapy, transverse friction
• Neurodynamic techniques: for accompanying nerve gliding restrictions
• Taping: supportive in everyday life or sport
• Workplace ergonomics: Adjust mouse/keyboard, forearm rest, neutral wrist position, light tools

Important: The exercises can be challenging, but should not clearly provoke pain. Increase stimuli slowly and continuously.

Injections and regenerative procedures – with a sense of proportion

More invasive measures may be considered if consistent conservative therapy over several weeks to months is not sufficient. We clarify the benefits, risks and the evidence base transparently.

• Cortisone injection: may provide short-term pain relief, but is associated with increased risk of relapse and potential tendon weakening. If anything, very reserved and not repeated.
• Autologous conditioned plasma (PRP): an option for chronic courses (>3–6 months); Study situation mixed. We discuss individual prospects of success and costs.
• Dry needling/percutaneous tenotomy: ultrasound-assisted needling for tough tendinoses as a case-by-case decision.
• Shock wave therapy (ESWT): can improve pain and function in selected cases; Effect often after several sessions.

Regenerative therapies do not replace active training - they can support healing if a structured exercise program is carried out in parallel.

Surgery – rarely necessary, clearly justified

Surgery is considered if, despite consistent conservative therapy, relevant symptoms persist for at least 6-12 months and everyday life or work is severely restricted.

• Procedure: partial release/debridement of the ECRB tendon origin, open or arthroscopic
• Goal: Removal of degenerative tendon parts, promotion of blood circulation, relief of pressure
• Follow-up treatment: Short-term immobilization, early mobilization, gradual strength building over weeks
• Chances of success: with the right indication, there is often good reduction in symptoms, individual results vary

We provide independent advice and make the decision together – with realistic expectations and no promise of cure.

Rehabilitation, everyday life and sport

• Pain management: adapt activities instead of complete protection; Use aids for a short time
• Return to work: gradual; If necessary, temporary protective activity, ergonomic adjustments
• Return to Sport: technical correction (e.g. grip strength, racket stringing), slow increase in load
• Training principle: eccentric exercises 2–4x/week, later combined strength/coordination stimuli

Self-help: exercises and ergonomics

Exercises should be easy to feel but tolerable. If symptoms increase significantly, reduce the dose and consult a professional.

forecast

The overall prognosis is good. Many patients achieve significant improvement within 6-12 months. Consistent exercise, clever load control and patience are crucial. Chronic processes often require a multi-stage concept and close support.

Prevention

• Increase the load slowly and incorporate micro-breaks
• Train technology (sports/crafts), choose suitable equipment
• Strengthening and stretching the forearm muscles 2-3x/week
• set up the workplace ergonomically; Avoid repetitive peak loads

When to see a doctor? Warning signs

• Severe pain or sudden loss of strength after a “bang” (differential diagnosis of tendon rupture)
• Numbness, tingling, radiating pain into the hand (nerve involvement)
• Swelling, overheating, fever (signs of infection - rarely on the elbow, but need to be clarified)
• Fall/trauma with persistent pain (fracture/ligament injury excluded)

Differential diagnoses

• Radial tunnel/supinator syndrome (nerve irritation)
• Cervical radiculopathy (C6/C7) with arm/hand radiation
• Osteoarthritis/plica syndrome of the elbow
• Tendonitis of other forearm muscles
• Golfer's elbow (medial epicondylitis)
• Distal biceps or triceps tendon pathology

Work, everyday life, fitness for sports

The ability to work depends on the activity. Office work is often possible with adjustments; Manual work may require temporary protection or aids. In sport, technical training comes first, followed by dosage and adequate material.

Your path to our practice in Hamburg

At Dorotheenstraße 48, 22301 Hamburg (Winterhude), we clarify your complaints in a structured manner: anamnesis, functional examination, ultrasound and – if appropriate – additional diagnostics. Based on the findings, we will create a step-by-step plan with you with clear goals: pain reduction, functional development, return to everyday life and sport.

• Conservative therapy first: exercise program, ergonomics, orthosis if necessary, physiotherapy
• Optional additional procedures such as ESWT or PRP after informed consent and indication
• Closely coordinated progress and success controls
• Cooperation with physiotherapy network in Hamburg

The costs of individual additional services (e.g. PRP, shockwave) depend on the scope and insurance status. We will inform you transparently in advance.