You may experience some or all the following:

• Pain on outside of forearm around elbow
• Tenderness at bony bump, sometimes swelling  
• Worse for bending, lifting, griping, twisting, turning handles  
• Difficulty to extend arm 
• Usually unilateral

Overuse of muscles around the forearm causes tendons attaching to bones at the elbow to be strained and subject to tears due to constant tugging. Initially inflammation is present. The most damage is in extensor carpi radial brevis with microtears and gradual wear.

It can be caused by sporting activities:

• Tennis, squash, fencing
• Non sporting activities with repeated stress at the elbow:  
• Using tools, screwdrivers etc., kneading bread, plumbing, typing, knitting, car mechanics, chefs, musicians etc.  

The most common tests to diagnose Tennis Elbow are:

First approach:

• what symptoms you’re experiencing
• when they started
• how long you’ve had them

Imagery test

• an X-ray
• a MRI scan
• an ultrasound scan

Home Treatment

This condition has a high success rate of recovery but it can take months to go back to normal, up to 2 years. You can play an active part in speeding up your recovery.

• Avoid the strenuous pain triggering activity 
• Rest for a few days  
• Ice cubes in cling film/thin towel around the lateral epicondyle only, 20 min every 3 hrs 3 days, ice massage 
• Elbow strap to create a false attachment site so tendons are not strained at their anatomical attachment and allowed to rest and heal 

 Treatments have been proven to help 

• Stretching and strengthening arm and wrist
• Manual therapy: mobilisation, massage, acupuncture, mobility exercises, eccentric exercises three times a day 1-3 months as soon as pain allows 
• Therapeutic ultrasound 
• Physiotherapy and Osteopathy: manipulation to improve range of movement, often the joint is restricted so the muscles have to work harder and from a disadvantaged position 

What can you do to help with the recovery?

Check racquet strings, head, too heavy or too large, golf club and technique, check your equipment and use ergonomics when appropriate.    

Return to activity gradual when: Pain free load bearing on arm, Pain free in all range of movement and No swelling 

Maintain a good posture all the time to avoid recurrence